Healthcare Provider Details

I. General information

NPI: 1265794531
Provider Name (Legal Business Name): ELIZABETH HENRY IRELAND RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 CHAMBERS ST
SOUTH OGDEN UT
84403-4571
US

IV. Provider business mailing address

982 CHAMBERS STREET
SOUTH OGDEN UT
84403
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-4105
  • Fax: 801-584-2590
Mailing address:
  • Phone: 801-479-4105
  • Fax: 801-584-2590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number222849-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: