Provider Demographics
NPI:1912430588
Name:WASATCH MIDWIFERY AND WELLNESS, LLC
Entity type:Organization
Organization Name:WASATCH MIDWIFERY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MIDIWFE
Authorized Official - Prefix:
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:CPM, LDEM
Authorized Official - Phone:385-237-1568
Mailing Address - Street 1:6440 S WASATCH BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3539
Mailing Address - Country:US
Mailing Address - Phone:385-237-1568
Mailing Address - Fax:385-557-5623
Practice Address - Street 1:6440 S WASATCH BLVD
Practice Address - Street 2:STE 140
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84121
Practice Address - Country:US
Practice Address - Phone:385-237-1568
Practice Address - Fax:385-557-5623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1039762133V00000X
UT200580-8902163W00000X
171100000X, 175F00000X, 363LF0000X, 176B00000X
UT11111671174N00000X
UT200580-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty