Provider Demographics
NPI:1811271000
Name:BJARNSON, DIANNE GWEN (LDEM)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:GWEN
Last Name:BJARNSON
Suffix:
Gender:F
Credentials:LDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2056
Mailing Address - Country:US
Mailing Address - Phone:801-785-9272
Mailing Address - Fax:801-642-4425
Practice Address - Street 1:1243 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2056
Practice Address - Country:US
Practice Address - Phone:801-785-9272
Practice Address - Fax:801-642-4425
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6326927-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife