Individual
NICOLE AUDREY NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-1619
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14248504-1206
UT
363A00000X
Physician Assistant
—
NV
Other
Enumeration date
12/08/2021
Last updated
11/14/2025
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