MEDICARE: KIMBERLY ONILE-OGYGIA LDEM, CPM, JD, CD

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	374J00000X	Doula
2	176B00000X	Midwife	14187590-3400	UT
3	176B00000X	Midwife

General Provider Information

NPI Number	:	1427564756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ONILE-OGYGIA LDEM, CPM, JD, CD

Provider Business Mailing Address
First Line	:	239 E SOUTH TEMPLE APT 503
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1288
Country	:	US
Telephone Number	:	816-695-2998
Fax Number	:

Provider Business Practice Location Address
First Line	:	243 E 400 S STE 200
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-2841
Country	:	US
Telephone Number	:	816-695-2998
Fax Number	:

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

Provider Enumeration Date	:	12/22/2017
Last Update Date	:	01/15/2025

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