Healthcare Provider Details

I. General information

NPI: 1700441672
Provider Name (Legal Business Name): BEAUTIFUL MOUNTAIN BIRTH & MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 S JORDAN LANDING BLVD STE 120&130
WEST JORDAN UT
84084-5610
US

IV. Provider business mailing address

826 E 12300 S STE 2
DRAPER UT
84020-8276
US

V. Phone/Fax

Practice location:
  • Phone: 801-252-6243
  • Fax:
Mailing address:
  • Phone: 801-252-6243
  • Fax: 801-901-4531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: ANGIE RENA BLACKETT
Title or Position: OWNER/DIRECTOR
Credential: CPM, LDEM
Phone: 801-200-1873