Provider Demographics
NPI:1104687391
Name:STILL LLC DBA THE CENTER MEDICAL
Entity type:Organization
Organization Name:STILL LLC DBA THE CENTER MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP FNP-C
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-874-4954
Mailing Address - Street 1:12481 S FORT ST STE 150
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-2112
Mailing Address - Country:US
Mailing Address - Phone:801-874-4954
Mailing Address - Fax:888-571-6267
Practice Address - Street 1:12481 S FORT ST STE 150
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-2112
Practice Address - Country:US
Practice Address - Phone:801-874-4954
Practice Address - Fax:888-571-6267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty