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General NPI Number Information
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NPI Number | 1568242576
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Entity Type | Individual
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Provider Name | JUSTIN STANSFIELD NP
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Gender | Male
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Dates
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Enumeration Date | 10/05/2023
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 1400 S DEPOT DR
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City | OGDEN
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State | UT
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Zip | 84404-5573
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Country | US
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Telephone | 801-778-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 5434 S 3675 W
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City | ROY
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State | UT
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Zip | 84067-9243
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Country | US
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Telephone | 801-726-3578
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9415330-4405
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License Number State | UT
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