Individual
NICOLE PAGE NIELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10207 S BANNOR HILL RD, SANDY, UT 84092-6105
(720) 955-2105
Mailing address
10207 S BANNOR HILL RD, SANDY, UT 84092-6105
(720) 955-2105
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12488179-1206
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/29/2021
Last updated
12/20/2021
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