MEDICARE: MR. DANIEL C FERNELIUS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	10962614-4405	UT

General Provider Information

NPI Number	:	1043184005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL C FERNELIUS FNP-C

Provider Business Mailing Address
First Line	:	3401 N THANKSGIVING WAY STE 190
Second Line	:
City	:	LEHI
State	:	UT
Zip	:	84048-4157
Country	:	US
Telephone Number	:	385-454-5027
Fax Number	:	801-742-8381

Provider Business Practice Location Address
First Line	:	3401 N THANKSGIVING WAY STE 190
Second Line	:
City	:	LEHI
State	:	UT
Zip	:	84048-4157
Country	:	US
Telephone Number	:	385-454-5027
Fax Number	:	801-742-8381

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2025
Last Update Date	:	10/02/2025

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