Individual
SELENE INGRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1055 N 500 W, STE 201 BLDG C, PROVO, UT 84604
(801) 429-8000
(801) 429-8150
Mailing address
1055 N 500 W, ATTN CREDENTIALING, PROVO, UT 84604
(801) 354-8225
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
8513908-4405
UT
Other
Enumeration date
06/03/2025
Last updated
06/20/2025
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