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General NPI Number Information
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NPI Number | 1831563501
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Entity Type | Individual
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Provider Name | KATIA LECUYER LDEM, CPM
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Gender | Female
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 12/09/2020
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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 | 1222 E 900 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84105-1528
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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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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 | 9472656-3400
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License Number State | UT
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