Provider Demographics
NPI:1598407991
Name:MILLER, CRYSTAL BREKKE (CNM)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:BREKKE
Last Name:MILLER
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 1:1925 E 70 S
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-4451
Mailing Address - Country:US
Mailing Address - Phone:619-540-0505
Mailing Address - Fax:
Practice Address - Street 1:345 E GATEWAY DR STE 150
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-4625
Practice Address - Country:US
Practice Address - Phone:619-540-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9102898-3102163WM0102X
UT9102898-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn