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General NPI Number Information
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NPI Number | 1922856616
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Entity Type | Individual
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Provider Name | ELISE WRIGHT
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Gender | Female
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Dates
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Enumeration Date | 05/08/2024
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 1800 NOVELL PL
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City | PROVO
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State | UT
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Zip | 84606-6171
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Country | US
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Telephone | 480-388-2808
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Fax |
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Provider Business Mailing Address
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Address Line | 3556 W 9800 S STE 101
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-3221
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Country | US
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Telephone | 801-567-9780
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 14252273-1206
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License Number State | UT
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