Provider Demographics
NPI:1104008945
Name:ELHALTA, VALERIE J
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:J
Last Name:ELHALTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4048 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-4244
Mailing Address - Country:US
Mailing Address - Phone:801-472-4102
Mailing Address - Fax:
Practice Address - Street 1:4048 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-4244
Practice Address - Country:US
Practice Address - Phone:801-472-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175M00000X
UTNA175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay