=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336960921
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN ELAINE WEBB FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2024
-----------------------------------------------------
Last Update Date | 10/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1393 E SEGO LILY DR
-----------------------------------------------------
City | SANDY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84092-4350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-619-9000
-----------------------------------------------------
Fax | 801-619-9001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10923 S CORALVILLE WAY
-----------------------------------------------------
City | SOUTH JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84009-7727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-867-0497
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 6211044-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------