Provider Demographics
NPI:1811788821
Name:THURMAN, DREW ROBERT
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:ROBERT
Last Name:THURMAN
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 1:366 W 3300 S
Mailing Address - Street 2:
Mailing Address - City:NIBLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6346
Mailing Address - Country:US
Mailing Address - Phone:801-722-5564
Mailing Address - Fax:
Practice Address - Street 1:366 W 3300 S
Practice Address - Street 2:
Practice Address - City:NIBLEY
Practice Address - State:UT
Practice Address - Zip Code:84321-6346
Practice Address - Country:US
Practice Address - Phone:801-722-5564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11307485-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner