Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1144758848 |
---|---|
Provider Name | Krista Lynn Miracle |
First Address | Farmington, UT 84025-5003 |
Second Address | Farmington, UT 84025-5003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2017 |
Last Update Date | 25/05/2017 |