Healthcare Provider Details

I. General information

NPI: 1972377307
Provider Name (Legal Business Name): CHELSEY MILLER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 W 7000 S FL 1
WEST JORDAN UT
84084-3431
US

IV. Provider business mailing address

329 E MAIN ST
FAIRFIELD UT
84013-1302
US

V. Phone/Fax

Practice location:
  • Phone: 801-569-9133
  • Fax: 801-569-9103
Mailing address:
  • Phone: 801-367-1179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10643473-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: