Healthcare Provider Details

I. General information

NPI: 1134861727
Provider Name (Legal Business Name): COURTNEY BROOKE SHILL RUSSELL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY SHILL

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 W CROSSROADS BLVD
SARATOGA SPRINGS UT
84045-5506
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-341-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number14279173-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: