| NPI | 1679250146 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD LILJENQUIST Owner 801-420-2516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 213E00000X Podiatrist |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2024-02-29 |