Provider Demographics
NPI:1902371826
Name:ELLEFSEN, JENNIFER MORGAN (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MORGAN
Last Name:ELLEFSEN
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:GRACE ANN
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, NP-C
Mailing Address - Street 1:704 S 1600 W STE 103
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664-4462
Mailing Address - Country:US
Mailing Address - Phone:385-325-0311
Mailing Address - Fax:
Practice Address - Street 1:704 S 1600 W STE 103
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-4462
Practice Address - Country:US
Practice Address - Phone:385-325-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-07
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10926118-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily