Healthcare Provider Details

I. General information

NPI: 1366927832
Provider Name (Legal Business Name): ELISE MEGAN CORBETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S 1000 E STE 300
PAYSON UT
84651
US

IV. Provider business mailing address

1055 N 500 W ATTN: CREDENTIALING
PROVO UT
84604
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-4896
  • Fax: 801-465-0606
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9037470-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: