MEDICARE: JACOLIN DEHLER SHIFRAR CNM

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	367A00000X	Advanced Practice Midwife	201432-4402	UT

General Provider Information

NPI Number	:	1134261209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOLIN DEHLER SHIFRAR CNM

Provider Business Mailing Address
First Line	:	3570 W 9000 S
Second Line	:	#210
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-8876
Country	:	US
Telephone Number	:	801-569-2626
Fax Number	:	801-569-5333

Provider Business Practice Location Address
First Line	:	3570 W 9000 S
Second Line	:	#210
City	:	WEST JORDAN
State	:	UT
Zip	:	84088-8876
Country	:	US
Telephone Number	:	801-569-2626
Fax Number	:	801-569-5333

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	02/22/2012

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