Provider Demographics
NPI:1770862773
Name:DICKEN, MELODY PENDLETON (CPM, LM)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:PENDLETON
Last Name:DICKEN
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:SMITH
Other - Last Name:PENDLETON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPM, LM
Mailing Address - Street 1:990 E 400 N
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-3671
Mailing Address - Country:US
Mailing Address - Phone:801-836-4559
Mailing Address - Fax:
Practice Address - Street 1:990 E 400 N
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-3671
Practice Address - Country:US
Practice Address - Phone:801-836-4559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY006OtherLICENSED MIDWIFE
00020006OtherNARM CERTIFIED PROFESSIONAL MIDWIFE