Provider Demographics
NPI:1528422805
Name:BELLISTON, ROBIN (CPM)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BELLISTON
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 S 250 E
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84318-3551
Mailing Address - Country:US
Mailing Address - Phone:435-232-0193
Mailing Address - Fax:
Practice Address - Street 1:295 S 250 E
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:UT
Practice Address - Zip Code:84318-3551
Practice Address - Country:US
Practice Address - Phone:435-232-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife