Healthcare Provider Details

I. General information

NPI: 1578086740
Provider Name (Legal Business Name): PATRICIA ELLSWORTH DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2132 N 1700 W STE 110
LAYTON UT
84041-7059
US

IV. Provider business mailing address

2344 N 840 W
CLINTON UT
84015-9726
US

V. Phone/Fax

Practice location:
  • Phone: 801-779-3500
  • Fax: 801-779-3508
Mailing address:
  • Phone: 801-540-2698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5232048-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5232048-4405
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number5232048
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: