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General NPI Number Information
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NPI Number | 1134776065
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Entity Type | Organization
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Legal Business Name | MIRACLE MIDWIFERY BIRTH CENTER, LLC
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Dates
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Enumeration Date | 08/26/2019
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Last Update Date | 08/26/2019
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Provider Practice Location Address
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Address Line | 360 S FORT LN STE 1B
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City | LAYTON
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State | UT
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Zip | 84041-5700
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Country | US
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Telephone | 801-923-8806
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Fax | 801-447-6037
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Provider Business Mailing Address
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Address Line | 360 S FORT LN STE 1B
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City | LAYTON
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State | UT
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Zip | 84041-5700
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Country | US
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Telephone | 801-923-8806
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Fax | 801-447-6037
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | KRISTA LYNN MIRACLE
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Credential | CPM
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Telephone | 801-923-8806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State |
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