MEDICARE: DR. PATRICIA ELLSWORTH DNP

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
1	363LF0000X	Family Nurse Practitioner	5232048-4405	UT
2	363L00000X	Nurse Practitioner	5232048-4405	UT
3	163W00000X	Registered Nurse	5232048	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578086740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA ELLSWORTH DNP

Provider Business Mailing Address
First Line	:	2344 N 840 W
Second Line	:
City	:	CLINTON
State	:	UT
Zip	:	84015-9726
Country	:	US
Telephone Number	:	801-540-2698
Fax Number	:

Provider Business Practice Location Address
First Line	:	2132 N 1700 W
Second Line	:	STE 110
City	:	LAYTON
State	:	UT
Zip	:	84041-7059
Country	:	US
Telephone Number	:	801-779-3500
Fax Number	:	801-779-3508

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	06/01/2022

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