Provider Demographics
NPI:1366073967
Name:STIKA, ELIZABETH ELLSWORTH (CPM, LDEM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ELLSWORTH
Last Name:STIKA
Suffix:
Gender:F
Credentials:CPM, LDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S STATE ST STE C1
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-6346
Mailing Address - Country:US
Mailing Address - Phone:801-225-5668
Mailing Address - Fax:425-795-9009
Practice Address - Street 1:560 S STATE ST STE C1
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-6346
Practice Address - Country:US
Practice Address - Phone:801-225-5668
Practice Address - Fax:425-795-9009
Is Sole Proprietor?:No
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9514053-3400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife