Provider Demographics
NPI:1982253118
Name:IRVINE, DESIREE (DEM)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:
Last Name:IRVINE
Suffix:
Gender:F
Credentials:DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 GROUSE DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-2922
Mailing Address - Country:US
Mailing Address - Phone:435-772-5796
Mailing Address - Fax:435-215-4517
Practice Address - Street 1:154 GROUSE DR
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-2922
Practice Address - Country:US
Practice Address - Phone:435-772-5796
Practice Address - Fax:435-215-4517
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay