Provider Demographics
NPI:1295465227
Name:LAING, MYLIE RAINE (CMP)
Entity Type:Individual
Prefix:
First Name:MYLIE
Middle Name:RAINE
Last Name:LAING
Suffix:
Gender:F
Credentials:CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11029 N WALLACE LN
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-9543
Mailing Address - Country:US
Mailing Address - Phone:435-237-2179
Mailing Address - Fax:
Practice Address - Street 1:11029 N WALLACE LN
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-9543
Practice Address - Country:US
Practice Address - Phone:435-237-2179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife