Individual
MARIYA NIKOLAEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1685 W 2200 S, SALT LAKE CITY, UT 84119-1456
(801) 478-7705
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
12492182-1206
UT
363A00000X
Physician Assistant
Primary
12492182-1206
UT
Other
Enumeration date
08/23/2019
Last updated
05/25/2022
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