Individual
MARLEY RAE NIELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
333 N 18TH AVE STE B3, POCATELLO, ID 83201-3358
(208) 232-2146
Mailing address
882 HIGHLAND BLVD, POCATELLO, ID 83204-4733
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/05/2019
Last updated
09/05/2019
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