Individual
JACOB NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8606 N 11600 W, THATCHER, UT 84337-9103
(435) 723-8548
Mailing address
82 S 800 W, BRIGHAM CITY, UT 84302-2400
(435) 723-8548
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/17/2015
Last updated
08/17/2015
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