Provider Demographics
NPI:1699791095
Name:FUTRELL, NANCY N (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:N
Last Name:FUTRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7930 S MAJESTIC RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5789
Mailing Address - Country:US
Mailing Address - Phone:801-263-0611
Mailing Address - Fax:801-263-9141
Practice Address - Street 1:7930 S MAJESTIC RIDGE DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-5789
Practice Address - Country:US
Practice Address - Phone:801-946-1000
Practice Address - Fax:801-263-9141
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0676142084N0400X
UT16893212052084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT30000004S2HVEASOtherCMS EHR CERTIFICATION ID
UT527645756006Medicaid
UT30000004S2HVEASOtherCMS EHR CERTIFICATION ID
UTF01761Medicare UPIN