Healthcare Provider Details

I. General information

NPI: 1487248373
Provider Name (Legal Business Name): CHELSEA LEE ELLSWORTH DNP, FNP-C, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA LEE MALNAR

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 04/03/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6932 E 1400 S
FORT DUCHESNE UT
84026
US

IV. Provider business mailing address

PO BOX 160
FORT DUCHESNE UT
84026-0160
US

V. Phone/Fax

Practice location:
  • Phone: 435-725-6850
  • Fax: 435-725-6897
Mailing address:
  • Phone: 435-725-6850
  • Fax: 435-725-6897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9404070-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: