Individual
DR. SARA MARIE ELLIS SIMONSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM, MSPH, PHD
Contact information
Practice address
650 ROUND VALLEY DR, PARK CITY, UT 84060-7571
(435) 333-1500
Mailing address
10 S 2000 E RM 410, SALT LAKE CITY, UT 84112-5880
(801) 585-9360
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
5037536-4402
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5037536-4402
CNM LICENSE
UT
Enumeration date
01/31/2019
Last updated
01/31/2019
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