Individual
NICKOLAS WHITESIDES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5664 ASPEN CT, SOUTH OGDEN, UT 84403-5919
(801) 452-3346
Mailing address
5664 ASPEN CT, SOUTH OGDEN, UT 84403-5919
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
UT
Other
Enumeration date
03/29/2017
Last updated
08/23/2017
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