Individual
MOLLI A NEILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4650 HARRISON BLVD, OGDEN, UT 84403-4303
(801) 475-3075
(801) 475-3076
Mailing address
PO BOX 5546, DENVER, CO 80217-5546
(801) 475-3075
(801) 475-3076
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7773064-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
UT
Enumeration date
09/15/2017
Last updated
09/15/2017
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