Provider Demographics
NPI:1568242576
Name:STANSFIELD, JUSTIN (NP)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:STANSFIELD
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5434 S 3675 W
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-9243
Mailing Address - Country:US
Mailing Address - Phone:801-726-3578
Mailing Address - Fax:
Practice Address - Street 1:1400 S DEPOT DR
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-5573
Practice Address - Country:US
Practice Address - Phone:801-778-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9415330-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily