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General NPI Number Information
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NPI Number | 1962149823
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Entity Type | Individual
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Provider Name | JENNIFER BERTAGNOLE CPM
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Gender | Female
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Dates
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Enumeration Date | 05/12/2022
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 993 S 800 W
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City | WOODS CROSS
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State | UT
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Zip | 84087-2056
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Country | US
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Telephone | 801-695-5134
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1674
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City | BOUNTIFUL
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State | UT
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Zip | 84011-1674
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Country | US
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Telephone | 801-695-5134
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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 | 9585456-3400
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License Number State | UT
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