Individual
KENNETH G NIELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1160 E 3900 S, STE 2000, SALT LAKE CITY, UT 84124-1202
(801) 266-3418
(801) 288-4444
Mailing address
PO BOX 741729, ATLANTA, GA 30374-1729
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
183758-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10301
—
UT
Enumeration date
08/17/2005
Last updated
11/27/2020
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