Healthcare Provider Details

I. General information

NPI: 1104008945
Provider Name (Legal Business Name): MRS. VALERIE J ELHALTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4048 RUSSELL RD
EAGLE MOUNTAIN UT
84005-4244
US

IV. Provider business mailing address

4048 RUSSELL RD
EAGLE MOUNTAIN UT
84005-4244
US

V. Phone/Fax

Practice location:
  • Phone: 801-472-4102
  • Fax:
Mailing address:
  • Phone: 801-472-4102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberNA
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: