Healthcare Provider Details

I. General information

NPI: 1285671446
Provider Name (Legal Business Name): JUSTIN DOUGLAS WILIIAMS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 E MEDICAL WAY
HEBER CITY UT
84032-1391
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 435-658-6738
  • Fax:
Mailing address:
  • Phone: 435-658-6738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number355105-4406
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: