Healthcare Provider Details

I. General information

NPI: 1043184005
Provider Name (Legal Business Name): DANIEL C FERNELIUS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N THANKSGIVING WAY STE 190
LEHI UT
84048-4157
US

IV. Provider business mailing address

3401 N THANKSGIVING WAY STE 190
LEHI UT
84048-4157
US

V. Phone/Fax

Practice location:
  • Phone: 385-454-5027
  • Fax: 801-742-8381
Mailing address:
  • Phone: 385-454-5027
  • Fax: 801-742-8381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number10962614-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: