Healthcare Provider Details

I. General information

NPI: 1902649593
Provider Name (Legal Business Name): MOUNTAIN HEART MIDWIFERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2024
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 FRONT ST
EVANSTON WY
82930-3581
US

IV. Provider business mailing address

101 GREASEWOOD LN
EVANSTON WY
82930-4947
US

V. Phone/Fax

Practice location:
  • Phone: 307-679-9965
  • Fax:
Mailing address:
  • Phone: 307-679-9965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANA HARTZELL
Title or Position: OWNER
Credential: CPM, BSM
Phone: 307-679-9965