Healthcare Provider Details

I. General information

NPI: 1316191174
Provider Name (Legal Business Name): CHESLEY ELLEN WELLS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 06/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 COTTONWOOD ST HOSPITALISTS
MURRAY UT
84107-7000
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-4384
  • Fax: 801-507-4398
Mailing address:
  • Phone: 801-507-4384
  • Fax: 801-507-4398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7471285-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number7471285-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: