MEDICARE: ELLA JORDAN WHITE DNP-S

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	163WN0002X	Neonatal Intensive Care Registered Nurse	12456156-3102	UT
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1801687504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLA JORDAN WHITE DNP-S

Provider Business Mailing Address
First Line	:	1090 E 500 S
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84010-3054
Country	:	US
Telephone Number	:	801-698-8251
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 S 2000 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5880
Country	:	US
Telephone Number	:	801-581-3414
Fax Number	:

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

Provider Enumeration Date	:	05/14/2025
Last Update Date	:	05/14/2025

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