=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457631046
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER LEIGH WHITLEY CPM, LDEM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2011
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1174 GRAYSTONE WAY STE 2
-----------------------------------------------------
City | SLC
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-556-1483
-----------------------------------------------------
Fax | 802-304-1011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 522332
-----------------------------------------------------
City | SLC
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84152-2332
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-556-1483
-----------------------------------------------------
Fax | 802-304-1011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | 107.0076820
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------