Provider Demographics
NPI:1548612013
Name:BARTLETT, JESSICA JANE (CNM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANE
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 N 500 E
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-1941
Mailing Address - Country:US
Mailing Address - Phone:801-368-8504
Mailing Address - Fax:
Practice Address - Street 1:177 N 500 E
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-1941
Practice Address - Country:US
Practice Address - Phone:801-368-8504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-08
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016021962367A00000X
UT7949291-4402176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife