MEDICARE: MS. KATELIN HALLIGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175M00000X	Lay Midwife

General Provider Information

NPI Number	:	1083089452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATELIN HALLIGAN

Provider Business Mailing Address
First Line	:	5107 S 900 E STE 140
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-6630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5107 S 900 E STE 140
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-6630
Country	:	US
Telephone Number	:	801-288-2229
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2015
Last Update Date	:	12/10/2015

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