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Justin Alan Illum
Family Nurse Practitioner in Midvale, Utah
NPI 1265174452

Justin Alan Illum is a Family Nurse Practitioner based in Midvale, UT and is specialized in Family. Justin Alan Illum practices in Midvale, UT. The NPI Number for Justin Alan Illum is 1265174452 and holds a License No. (Utah).

The current practice location address for Justin Alan Illum is 971 E Creekhill Ln Apt 10, Midvale, UT and can be reached out via phone at 417-693-3850.

Location: 971 E Creekhill Ln Apt 10, Midvale, UT, 84047-2365
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1265174452
Provider Name
Justin Alan Illum
Credential
Provider Entity Type
Individual
Gender
Male
Address
971 E Creekhill Ln Apt 10, Midvale, UT, 84047-2365
Phone Number
417-693-3850
Fax Number
Provider Enumeration Date
04/08/2022
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
971 E Creekhill Ln Apt 10
City
Midvale
State
Utah
Zip
84047-2365
Phone Number
417-693-3850
Fax Number
person
Provider Business Mailing Address Details
Address
971 E Creekhill Ln Apt 10
City
Midvale
State
Utah
Zip
84047-2365
Phone Number
417-693-3850
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
10386297-4405 (Utah)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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