Individual provider · Type 1 NPI
Justin Alan Illum
Family Nurse Practitioner · Midvale, UT
NPI number
1265174452
Active
Practice location
971 E Creekhill Ln Apt 10
Midvale, UT 84047-2365
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | None listed |
| Family Nurse Practitioner Primary | 363LF0000X | 10386297-4405 (UT) |
Family Nurse Practitioner: Definition to come...
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About NPI 1265174452
Justin Alan Illum's National Provider Identifier is 1265174452, issued on Apr 8, 2022. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Midvale, UT. The record was last updated on Dec 8, 2024.