Individual
CARISSA ANNETTE ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1600 W ANTELOPE DR, LAYTON, UT 84041-1142
(801) 807-7177
Mailing address
1022 28TH ST W, WILLISTON, ND 58801-2925
(801) 450-7525
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PAC-0481
ND
Other
Enumeration date
05/11/2012
Last updated
10/23/2024
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