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Laurie Ellis

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NPI Number Detailed Information

Provider Information:

Name: Laurie Ellis
Gender: F
Provider License Number If Given: 2211674405

NPI Information:

NPI: 1770578254
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 9/12/2005

Last Update Date: 7/8/2007

Provider Business Mailing Address:

Address: 3920 S 1100 E
Salt Lake City, UT 84124
Phone Number: 8012668841
Fax Number: 8012660449

Provider Business Practice Location Address:

Address: 3920 S 1100 E
Salt Lake City, UT 84124
Phone Number: 8012668841
Fax Number: 8012660449

Provider Taxonomy:

Primary: 363L00000X
Secondary (if any):
State: UT

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