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NPI Code Detail

MEDICARE: CRYSTAL BREKKE MILLER CNM

MEDICARE: CRYSTAL BREKKE MILLER 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
1163WM0102XMaternal Newborn Registered Nurse9102898-3102UT
2367A00000XAdvanced Practice Midwife9102898-4402UT

General Provider Information

NPI Number : 1598407991
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL BREKKE MILLER CNM
Provider Business Mailing Address
First Line : 1925 E 70 S
Second Line :
City : HEBER CITY
State : UT
Zip : 84032-4451
Country : US
Telephone Number : 619-540-0505
Fax Number :
Provider Business Practice Location Address
First Line : 345 E GATEWAY DR STE 150
Second Line :
City : HEBER CITY
State : UT
Zip : 84032-4625
Country : US
Telephone Number : 619-540-0505
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2022
Last Update Date : 04/07/2022

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