Provider Demographics
NPI:1992194732
Name:JUSTIS, JULIA CHRISTENSEN (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:CHRISTENSEN
Last Name:JUSTIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4088 N HIGHWAY 91
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84318-4125
Mailing Address - Country:US
Mailing Address - Phone:801-563-4900
Mailing Address - Fax:
Practice Address - Street 1:4088 N HIGHWAY 91
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:UT
Practice Address - Zip Code:84318-4125
Practice Address - Country:US
Practice Address - Phone:801-563-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-16
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9701074-1206363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant