Individual
LAURIE ELLIS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
3920 S 1100 E, SALT LAKE CITY, UT 84124-1213
(801) 266-8841
(801) 266-0449
Mailing address
3920 S 1100 E, SALT LAKE CITY, UT 84124-1213
(801) 266-8841
(801) 266-0449
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2211674405
UT
Other
Enumeration date
09/12/2005
Last updated
07/08/2007
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