MEDICARE: MARCIA A. SCOVILLE C.N.M.

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	176B00000X	Midwife	214228-4402	UT

General Provider Information

NPI Number	:	1770615684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA A. SCOVILLE C.N.M.

Provider Business Mailing Address
First Line	:	2605 E 3300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2728
Country	:	US
Telephone Number	:	801-746-7467
Fax Number	:	801-746-7469

Provider Business Practice Location Address
First Line	:	2605 E 3300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2728
Country	:	US
Telephone Number	:	801-746-7467
Fax Number	:	801-746-7469

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/08/2007

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