Individual
SHIRLEY B ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1055 N 500 W, SUITE 202, PROVO, UT 84604-3305
(801) 374-2367
(801) 429-8015
Mailing address
1055 N 500 W, CREDENTIALING DEPARTMENT, PROVO, UT 84604-3305
(801) 354-8215
(801) 429-8180
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2629084405
UT
Other
Enumeration date
09/02/2006
Last updated
10/16/2007
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