Individual
BETHANY ROSE NICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
54 N 200 E, CEDAR CITY, UT 84720-2615
(435) 687-4770
Mailing address
54 N 200 E, CEDAR CITY, UT 84720-2615
(435) 687-4770
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
03/25/2010
Last updated
03/25/2010
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