Healthcare Provider Details

I. General information

NPI: 1477182913
Provider Name (Legal Business Name): ELIZABETH PAGE NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MCKAY PL
MOAB UT
84532-2945
US

IV. Provider business mailing address

440 MCKAY PL
MOAB UT
84532-2945
US

V. Phone/Fax

Practice location:
  • Phone: 443-739-7706
  • Fax:
Mailing address:
  • Phone: 443-739-7706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number13992076-3902
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: