Individual
STEPHANIE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN
Contact information
Practice address
395 W COUGAR BLVD STE 104, PROVO, UT 84604-3334
(801) 357-8200
(801) 357-8201
Mailing address
1121 E 3900 S STE C230, SALT LAKE CITY, UT 84124-1297
(801) 262-9494
(866) 415-6807
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
7558496-4405
UT
Other
Enumeration date
03/11/2022
Last updated
03/11/2022
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