JUSTIN ALAN ILLUM NPI 1265174452

NPI Information

NPI: 1265174452
Provider Name: JUSTIN ALAN ILLUM
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
971 E CREEKHILL LN APT 10
MIDVALE, UT
ZIP 84047
Phone: (417) 693-3850
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Justin Alan Illum is a family nurse practitioner in Midvale, UT with 1 years of experience. Justin Alan Illum NPI is 1265174452. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

971 E CREEKHILL LN APT 10
MIDVALE, UT
ZIP 84047-365
Phone: (417) 693-3850

The NPI 1265174452 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/8/2022 and was last updated on 8/12/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	390200000X	Student in an Organized Health Care Education/Training Program				No
2	363LF0000X	Nurse Practitioner	Family	10386297-4405	UTAH	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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