Individual
JACQUELYN ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
714 S STATE ST, OREM, UT 84058-6366
(801) 426-6565
Mailing address
714 S STATE ST, OREM, UT 84058-6366
(801) 426-6565
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
68347673101
UT
Other
Enumeration date
06/15/2018
Last updated
06/15/2018
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