Provider Demographics
NPI:1487248373
Name:ELLSWORTH, CHELSEA LEE (DNP, FNP-C, APRN)
Entity type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:LEE
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:DNP, FNP-C, APRN
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:LEE
Other - Last Name:MALNAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:FORT DUCHESNE
Mailing Address - State:UT
Mailing Address - Zip Code:84026-0160
Mailing Address - Country:US
Mailing Address - Phone:435-725-6850
Mailing Address - Fax:435-725-6897
Practice Address - Street 1:6932 E 1400 S
Practice Address - Street 2:
Practice Address - City:FORT DUCHESNE
Practice Address - State:UT
Practice Address - Zip Code:84026
Practice Address - Country:US
Practice Address - Phone:435-725-6850
Practice Address - Fax:435-725-6897
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9404070-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily