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General NPI Number Information
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NPI Number | 1144644048
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Entity Type | Organization
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Legal Business Name | BIRTHWISE MATERNITY CARE LC
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 02/12/2014
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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 | 801-928-9089
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Fax |
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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 |
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Fax |
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Authorized Official
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Title or Position | MIDWIFE
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Name | JANELL PETERSON
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Credential | CPM, LDEM
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Telephone | 801-928-9089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 88073083400
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License Number State | UT
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