Organization
MIRACLE MIDWIFERY BIRTH CENTER, LLC
Active
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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