Basic Information
| Provider Information | |||||||||
| NPI: | 1902371826 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELLEFSEN | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | MORGAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | APRN, NP-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MORGAN | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | GRACE ANN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | APRN, NP-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 800 W UNIVERSITY PKWY # MS 200 | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840586703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018638876 | ||||||||
| FaxNumber: | 8018636044 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 W UNIVERSITY PKWY # MS 200 | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018638876 | ||||||||
| FaxNumber: | 8018636044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2018 | ||||||||
| LastUpdateDate: | 12/07/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 10926118-4405 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.