MEDICARE: CRISTINA MARIE MCLENNAN

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	175M00000X	Lay Midwife

General Provider Information

NPI Number	:	1881436988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA MARIE MCLENNAN

Provider Business Mailing Address
First Line	:	732 S 1000 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-3618
Country	:	US
Telephone Number	:	760-415-3062
Fax Number	:

Provider Business Practice Location Address
First Line	:	732 S 1000 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-3618
Country	:	US
Telephone Number	:	760-415-3062
Fax Number	:

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

Provider Enumeration Date	:	06/10/2024
Last Update Date	:	06/10/2024

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Directions to “ CRISTINA MARIE MCLENNAN ” Practice Location

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