Provider Demographics
NPI:1992710602
Name:MILLCREEK WOMENS CENTER
Entity type:Organization
Organization Name:MILLCREEK WOMENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:V
Authorized Official - Last Name:KINIKINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-262-8666
Mailing Address - Street 1:1140 E 3900 S
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1228
Mailing Address - Country:US
Mailing Address - Phone:801-262-8666
Mailing Address - Fax:801-262-8666
Practice Address - Street 1:1140 E 3900 S
Practice Address - Street 2:SUITE 410
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1228
Practice Address - Country:US
Practice Address - Phone:801-262-8666
Practice Address - Fax:801-263-8821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3355524402207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty