Individual
MR. CRAIG A ENSIGN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS-PAC
Contact information
Practice address
1055 N 300 W STE 316, PROVO, UT 84604-3373
(801) 357-7530
(801) 357-7566
Mailing address
1055 N 300 W STE 316, PROVO, UT 84604-3373
(801) 357-7530
(801) 357-7566
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
293156-8906
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
96-293156-1206
PHYS ASSISTANT LIC #
UT
Enumeration date
07/04/2006
Last updated
07/08/2007
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