MEDICARE: REBECCA ANN MCINNIS 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	47473784402	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	72884	OTHER	UT	PEHP INSURANCE
2	4747378440001	OTHER	UT	BCBS INSURANCE

General Provider Information

NPI Number	:	1760526438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ANN MCINNIS CNM

Provider Business Mailing Address
First Line	:	4555 CREEK LN
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-3913
Country	:	US
Telephone Number	:	801-288-0087
Fax Number	:	801-278-3112

Provider Business Practice Location Address
First Line	:	2180 E 4500 S
Second Line	:	SUITE 150
City	:	HOLLADAY
State	:	UT
Zip	:	84117-4434
Country	:	US
Telephone Number	:	801-278-3102
Fax Number	:	801-278-3112

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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Directions to “ REBECCA ANN MCINNIS CNM” Practice Location

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