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NPI Code Detail

MEDICARE: MS. DEBORAH MARIE ELLIS CNM APRN

MEDICARE: MS. DEBORAH MARIE ELLIS CNM APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse2206804405UT
2367A00000XAdvanced Practice Midwife2206804402UT
3363LP0808XPsychiatric/Mental Health Nurse Practitioner220680-4405UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11841250602OTHERUTNPI FOR LEON HANSEN

General Provider Information

NPI Number : 1376746883
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DEBORAH MARIE ELLIS CNM APRN
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 801-233-4200
Fax Number :
Provider Business Practice Location Address
First Line : 1225 E FORT UNION BLVD
Second Line : STE 215
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84047-1889
Country : US
Telephone Number : 801-233-4200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2007
Last Update Date : 02/29/2016

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