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General NPI Number Information
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NPI Number | 1043184005
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Entity Type | Individual
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Provider Name | DANIEL C FERNELIUS FNP-C
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Gender | Male
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Dates
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Enumeration Date | 10/02/2025
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 3401 N THANKSGIVING WAY STE 190
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City | LEHI
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State | UT
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Zip | 84048-4157
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Country | US
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Telephone | 385-454-5027
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Fax | 801-742-8381
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Provider Business Mailing Address
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Address Line | 3401 N THANKSGIVING WAY STE 190
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City | LEHI
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State | UT
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Zip | 84048-4157
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Country | US
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Telephone | 385-454-5027
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Fax | 801-742-8381
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 10962614-4405
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License Number State | UT
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