Individual
MICHAEL LEE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1750 N WYMOUNT TERRACE DR, PROVO, UT 84602-1017
(801) 422-5156
(801) 422-0761
Mailing address
1750 N WYMOUNT TERRACE DR, PROVO, UT 84602-1017
(801) 422-5156
(801) 422-0761
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4884511-1206
UT
363A00000X
Physician Assistant
PA-2758
ID
363A00000X
Physician Assistant
PA-758
ID
363AS0400X
Surgical Physician Assistant
002266
IA
363AS0400X
Surgical Physician Assistant
0809
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326298787
—
IA
05
—
1326298787
—
NE
05
—
1326298787
—
SD
Enumeration date
09/23/2008
Last updated
03/19/2025
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