MEDICARE: ENCOMPASSING BIRTH MIDWIFERY, LLC

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	261QB0400X	Birthing Clinic/Center
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1639871478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENCOMPASSING BIRTH MIDWIFERY, LLC

Provider Business Mailing Address
First Line	:	937 E HILLVIEW DR APT B
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84124-1113
Country	:	US
Telephone Number	:	801-682-6464
Fax Number	:

Provider Business Practice Location Address
First Line	:	1148 E 2700 S APT 60
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84106-2647
Country	:	US
Telephone Number	:	801-682-6464
Fax Number	:

Authorized Official
Title or Position	:	MIDWIFE / OWNER
Name	:	SHANLEE ROBERTSON
Credential	:	CPM, LDEM, LM
Telephone Number	:	470-588-6464

Provider Enumeration Date	:	03/17/2023
Last Update Date	:	03/18/2024

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