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General NPI Number Information
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NPI Number | 1750924536
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Entity Type | Individual
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Provider Name | AUSTEN DIANE TULLIS DNP
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Gender | Female
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Dates
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Enumeration Date | 10/23/2019
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | BUILDING H-11, FREEPORT CENTER
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City | CLEARFIELD
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State | UT
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Zip | 84016
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Country | US
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Telephone | 801-774-3265
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Fax | 385-287-1978
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Provider Business Mailing Address
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Address Line | 1413 E BENT BROOK LN
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City | KAYSVILLE
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State | UT
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Zip | 84037-1386
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Country | US
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Telephone | 509-481-3741
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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 | 12962021-4405
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License Number State | UT
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