Healthcare Provider Details

I. General information

NPI: 1780494062
Provider Name (Legal Business Name): JUDE SALUMU
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 E 600 S
ST GEORGE UT
84770-3949
US

IV. Provider business mailing address

348 E 600 S
ST GEORGE UT
84770-3949
US

V. Phone/Fax

Practice location:
  • Phone: 435-705-7574
  • Fax:
Mailing address:
  • Phone: 435-705-7574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: