Provider Demographics
NPI:1033580634
Name:CROFTS, NELLI ALEXANDRA OLGA VI
Entity Type:Individual
Prefix:MS
First Name:NELLI
Middle Name:ALEXANDRA OLGA VI
Last Name:CROFTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NELLI
Other - Middle Name:ALEXANDRA OLGA VI
Other - Last Name:BONNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 E 8330 S
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2115
Mailing Address - Country:US
Mailing Address - Phone:208-871-6977
Mailing Address - Fax:
Practice Address - Street 1:2001 S STATE ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84190-0001
Practice Address - Country:US
Practice Address - Phone:385-468-4735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator