Organization
MIRACLE MIDWIFERY BIRTH CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA LYNN MIRACLE CPM (CLINICAL DIRECTOR)
(801) 923-8806
Entity
Organization
Contact information
Practice address
360 S FORT LN STE 1B, LAYTON, UT 84041-5700
(801) 923-8806
(801) 447-6037
Mailing address
360 S FORT LN STE 1B, LAYTON, UT 84041-5700
(801) 923-8806
(801) 447-6037
Taxonomy
Speciality
Code
Description
License number
State
261QB0400X
Birthing Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3013097
—
UT
Enumeration date
08/26/2019
Last updated
08/26/2019
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