Provider Demographics
NPI:1417737172
Name:NELSON, EMILY CAROLINE (NP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CAROLINE
Last Name:NELSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:CAROLINE
Other - Last Name:HENSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3063 W WILD FLOWER LN
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5526
Mailing Address - Country:US
Mailing Address - Phone:503-880-7088
Mailing Address - Fax:
Practice Address - Street 1:1881 W TRAVERSE PKWY STE D
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5994
Practice Address - Country:US
Practice Address - Phone:385-250-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11549817-4405207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology