JUSTIN ILLUM

Nurse Practitioner - Family

Active Individual
NPI: 1265174452

Practice Address

971 E CREEKHILL LN APT 10
Midvale, UT 84047

Phone: (417) 693-3850

Specialties

Specialty Code Primary License
Student in an Organized Health Care Education/Training Program 390200000X No -
Nurse Practitioner - Family 363LF0000X Yes 10386297-4405 (UT)

Frequently Asked Questions

NPI 1265174452 is the National Provider Identifier for JUSTIN ILLUM, a Nurse Practitioner - Family provider located in Midvale, UT. This NPI was enumerated on April 8, 2022.
JUSTIN ILLUM practices at 971 E CREEKHILL LN APT 10, Midvale, UT 84047.

Quick Facts

NPI
1265174452
Type
Individual
Enumerated
Apr 8, 2022
Last Updated
Dec 8, 2024

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