Healthcare Provider Details

I. General information

NPI: 1881091601
Provider Name (Legal Business Name): INGROWN TOENAILS ONLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 12/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 W 12600 S STE 120B
RIVERTON UT
84096-7401
US

IV. Provider business mailing address

4019 W 12600 S STE 120B
RIVERTON UT
84096-7401
US

V. Phone/Fax

Practice location:
  • Phone: 801-273-0001
  • Fax:
Mailing address:
  • Phone: 801-273-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN ELLSWORTH
Title or Position: DOCTOR
Credential: DPM
Phone: 801-273-0001