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General NPI Number Information
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NPI Number | 1407640949
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Entity Type | Individual
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Provider Name | LACEY BOEHMER CPM, LDEM
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Gender | Female
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 4359 S HIGHLAND DR
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City | HOLLADAY
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State | UT
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Zip | 84124-3539
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Country | US
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Telephone | 888-755-7155
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Fax | 801-723-3115
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Provider Business Mailing Address
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Address Line | 941 W ZAFFRE HILLS LN
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City | BLUFFDALE
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State | UT
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Zip | 84065-2004
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Country | US
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Telephone | 385-205-7010
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 11409200-3400
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License Number State | UT
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