Individual
THOMAS NILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-S
Contact information
Practice address
1800 NOVELL PL, PROVO, UT 84606-6171
(916) 756-5677
Mailing address
9298 ELDER CREEK RD, SACRAMENTO, CA 95829-9325
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/09/2025
Last updated
05/09/2025
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