Individual
AMANDA NICKELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7864 S SUMMER STATION WAY, MIDVALE, UT 84047-5723
(907) 687-1015
Mailing address
7864 S SUMMER STATION WAY, MIDVALE, UT 84047-5723
(907) 687-1015
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
08/29/2023
Last updated
08/19/2024
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