| NPI | 1831961804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRAD LILJENQUIST President 801-420-2516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2023-10-24 |
| Last Update Date | 2024-02-12 |