Individual
CODY NIELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
140 WHITE SAGE AVE, DELTA, UT 84624-8928
(435) 864-3333
(435) 864-2790
Mailing address
1055 N 500 W, PROVO, UT 84604-3305
(801) 812-4673
(801) 418-0941
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8434517-1206
UT
Other
Enumeration date
09/27/2012
Last updated
06/25/2014
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