Provider Demographics
NPI:1811397144
Name:GERMAN, ELISABETH EVE (LM, CPM)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:EVE
Last Name:GERMAN
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:EVE
Other - Middle Name:
Other - Last Name:GERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LM, CPM
Mailing Address - Street 1:5107 S 900 E
Mailing Address - Street 2:ST 140
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-6600
Mailing Address - Country:US
Mailing Address - Phone:801-288-2229
Mailing Address - Fax:
Practice Address - Street 1:5107 S 900 E
Practice Address - Street 2:ST 140
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-6600
Practice Address - Country:US
Practice Address - Phone:801-288-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9111152-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife