Provider Demographics
NPI:1144551417
Name:ELISON, ABBET L (LMT)
Entity type:Individual
Prefix:MISS
First Name:ABBET
Middle Name:L
Last Name:ELISON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 W 1650 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2581
Mailing Address - Country:US
Mailing Address - Phone:801-722-5176
Mailing Address - Fax:
Practice Address - Street 1:643 W 700 N
Practice Address - Street 2:SUITE C
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1361
Practice Address - Country:US
Practice Address - Phone:801-796-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6964225-4701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist