Healthcare Provider Details

I. General information

NPI: 1184990889
Provider Name (Legal Business Name): CHELSEA STEPHENSON MUTSCHELLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHELSEA ELIZABETH STEPHENSON

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E 9TH AVE SUITE 205
SALT LAKE CITY UT
84103-2877
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-408-6100
  • Fax:
Mailing address:
  • Phone: 801-408-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number9747634-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: