Provider Demographics
NPI:1043184005
Name:FERNELIUS, DANIEL C (FNP-C)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:C
Last Name:FERNELIUS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 N THANKSGIVING WAY STE 190
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84048-4157
Mailing Address - Country:US
Mailing Address - Phone:385-454-5027
Mailing Address - Fax:801-742-8381
Practice Address - Street 1:3401 N THANKSGIVING WAY STE 190
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84048-4157
Practice Address - Country:US
Practice Address - Phone:385-454-5027
Practice Address - Fax:801-742-8381
Is Sole Proprietor?:No
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10962614-4405207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine