Provider Demographics
NPI:1104675388
Name:SHERWIN, MICHELLE (CPM, LDEM)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SHERWIN
Suffix:
Gender:F
Credentials:CPM, LDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 W 1690 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-7224
Mailing Address - Country:US
Mailing Address - Phone:801-471-7416
Mailing Address - Fax:
Practice Address - Street 1:3270 W 1690 N
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-7224
Practice Address - Country:US
Practice Address - Phone:801-471-7416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14192876-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife