Active NPI
Jennifer Jeanine Ellstrom, FNP-C
- Family Nurse Practitioner
- Lehi, UT
National Provider Identifier
1699441626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 12124921-4405
- Practice address
- 3401 N Center St Ste 175
Lehi, UT 84043-7502 - Phone
- (801) 893-1872
- NPI assigned
- Aug 19, 2021
- Last updated
- Aug 19, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 12124921-4405 | UT | Primary |
Addresses
Primary practice location
3401 N Center St Ste 175
Lehi, UT 84043-7502
Mailing address
1756 W Park Ave
Riverton, UT 84065-4701
Phone (801) 893-1905
Other names 1
- Jennifer Jeanine Carlson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woundtech of Utah, Inc. | Current | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Infectious Disease Physician
- Salt Lake City, UT
- NPI 1750922415
-
- Primary Care Clinic/Center
- Riverton, UT
- NPI 1932285186
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629331200000",
"number": "1699441626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1756 W PARK AVE",
"city": "RIVERTON",
"state": "UT",
"postal_code": "840654701",
"telephone_number": "801-893-1905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3401 N CENTER ST STE 175",
"city": "LEHI",
"state": "UT",
"postal_code": "840437502",
"telephone_number": "801-893-1872"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLSTROM",
"first_name": "JENNIFER",
"middle_name": "JEANINE",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-19",
"last_updated": "2021-08-19",
"certification_date": "2021-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "UT",
"license": "12124921-4405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "CARLSON",
"middle_name": "JEANINE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Lehi, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.