=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033998398
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA HEATHER MAUCH CPM, LDEM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2023
-----------------------------------------------------
Last Update Date | 09/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 973 N 6000 W
-----------------------------------------------------
City | CORINNE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84307-9727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-709-8980
-----------------------------------------------------
Fax | 801-210-5797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 973 N 6000 W
-----------------------------------------------------
City | CORINNE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84307-9727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-709-8980
-----------------------------------------------------
Fax | 801-210-5797
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175M00000X
-----------------------------------------------------
Taxonomy Name | Lay Midwife
-----------------------------------------------------
License Number | 12347150-3400
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------