Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Justin Alan Illum

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1265174452

Justin Alan Illum is a Nurse Practitioner in Midvale, Utah. Qualified in 2023, 3 years ago. Practices with University of Utah Adult Services, a 1,740-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
3
Licensed in
UT
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

971 E Creekhill Ln Apt 10
Midvale, UT 84047-2365
Phone: (417) 693-3850
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 10386297-4405 (UT)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1265174452
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedApril 8, 2022
Last updated in NPPESDecember 8, 2024
Certification dateDecember 8, 2024
Mailing address971 E Creekhill Ln Apt 10, Midvale, UT 84047-2365

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice University Of Utah Adult Services — 1740 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Midvale