Provider Demographics
NPI:1558009373
Name:ROMNEY, ELISE
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:ROMNEY
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 1:136 W 200 S APT 104
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-5901
Mailing Address - Country:US
Mailing Address - Phone:801-874-0106
Mailing Address - Fax:
Practice Address - Street 1:136 W 200 S APT 104
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-5901
Practice Address - Country:US
Practice Address - Phone:801-874-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program