Provider Demographics
NPI:1134261209
Name:SHIFRAR, JACOLIN DEHLER (CNM)
Entity type:Individual
Prefix:
First Name:JACOLIN
Middle Name:DEHLER
Last Name:SHIFRAR
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 1:3570 W 9000 S
Mailing Address - Street 2:#210
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-8876
Mailing Address - Country:US
Mailing Address - Phone:801-569-2626
Mailing Address - Fax:801-569-5333
Practice Address - Street 1:3570 W 9000 S
Practice Address - Street 2:#210
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8876
Practice Address - Country:US
Practice Address - Phone:801-569-2626
Practice Address - Fax:801-569-5333
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT201432-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife