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General NPI Number Information
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NPI Number | 1336988476
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Entity Type | Organization
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Legal Business Name | REVEAL MEDSPA
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 814 S 1040 W
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City | PAYSON
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State | UT
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Zip | 84651-4614
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Country | US
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Telephone | 385-551-2929
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Fax |
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Provider Business Mailing Address
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Address Line | 969 S 640 E
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City | PAYSON
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State | UT
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Zip | 84651-1628
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Country | US
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Telephone | 801-367-6049
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. CHANTELLE ELMER
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Credential | NP
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Telephone | 801-367-6049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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