Provider Demographics
NPI:1407414980
Name:MIRACLE MIDWIFERY, LLC
Entity Type:Organization
Organization Name:MIRACLE MIDWIFERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MIRACLE
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LM
Authorized Official - Phone:801-923-8806
Mailing Address - Street 1:360 S FORT LN STE 1B
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5700
Mailing Address - Country:US
Mailing Address - Phone:801-923-8806
Mailing Address - Fax:
Practice Address - Street 1:360 S FORT LN STE 1B
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5700
Practice Address - Country:US
Practice Address - Phone:801-923-8806
Practice Address - Fax:801-447-6037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health