Provider Demographics
NPI:1306719349
Name:NUUSILA, SIONA TUTAU
Entity type:Individual
Prefix:
First Name:SIONA
Middle Name:TUTAU
Last Name:NUUSILA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12760 S PARK AVE UNIT 520
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-3422
Mailing Address - Country:US
Mailing Address - Phone:801-407-0047
Mailing Address - Fax:
Practice Address - Street 1:12760 S PARK AVE UNIT 520
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-3422
Practice Address - Country:US
Practice Address - Phone:801-407-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty