Healthcare Provider Details

I. General information

NPI: 1053229831
Provider Name (Legal Business Name): JULIA ANN PEIFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

762 E GABLES ST
MIDVALE UT
84047-1769
US

IV. Provider business mailing address

762 E GABLES ST
MIDVALE UT
84047-1769
US

V. Phone/Fax

Practice location:
  • Phone: 636-579-2200
  • Fax:
Mailing address:
  • Phone: 636-579-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number12699679-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: