Individual
RONALD BRENT NUTTALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.T.C.
Contact information
Practice address
BRIGHAM YOUNG UNIVERSITY, 173 RB, PROVO, UT 84602-2005
(801) 422-1628
Mailing address
2162 N 1450 E, PROVO, UT 84604-5754
(801) 375-0260
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
6317911-4810
UT
Other
Enumeration date
11/28/2011
Last updated
11/28/2011
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