Individual
MRS. ANGIE RENA BLACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CPM, LDEM
Contact information
Practice address
14443 S CHROME RD, HERRIMAN, UT 84096-1204
(801) 200-1873
Mailing address
14443 S CHROME RD, HERRIMAN, UT 84096-1204
(801) 200-1873
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08100017
NORTH AMERICAN REGISTRY OF MIDWIVES
—
01
—
286486-3102
UTAH STATE BOARD OF NURSING
UT
01
—
286486-3400
STATE LICENSE
UT
Enumeration date
07/09/2008
Last updated
02/04/2023
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