JUSTIN ALAN ILLUM NPI 1265174452

NPI Information

  • NPI: 1265174452
  • Provider Name: JUSTIN ALAN ILLUM
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 971 E CREEKHILL LN APT 10
    MIDVALE, UT
    ZIP 84047
  • Phone: (417) 693-3850

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NPI Details

Justin Alan Illum is a family nurse practitioner in Midvale, UT with 3 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 12/8/2024.

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
1390200000XStudent in an Organized Health Care Education/Training ProgramNo
2363LF0000XNurse PractitionerFamily10386297-4405UTAHYes

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: 11/21/2025

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