Provider Demographics
NPI:1447514120
Name:MAYEUX, JENNALYN DEBORAH (DNP)
Entity type:Individual
Prefix:
First Name:JENNALYN
Middle Name:DEBORAH
Last Name:MAYEUX
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:JENNALYN
Other - Middle Name:DEBORAH
Other - Last Name:ELLSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:26 N 1900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0002
Mailing Address - Country:US
Mailing Address - Phone:801-585-6433
Mailing Address - Fax:801-585-3355
Practice Address - Street 1:50 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-585-6433
Practice Address - Fax:801-585-3355
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2021-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5932217-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily