Healthcare Provider Details

I. General information

NPI: 1306516570
Provider Name (Legal Business Name): ELLI RUTH HUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 E 90 N STE 101
AMERICAN FORK UT
84003-2954
US

IV. Provider business mailing address

1248 E 90 N STE 101
AMERICAN FORK UT
84003-2954
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6904782-8900
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6904782-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: