Individual
ANDREW JOSEPH NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
607 E 200 S, SALT LAKE CITY, UT 84102-2110
(801) 430-0954
Mailing address
4981 S 4900 W, KEARNS, UT 84118-6316
(801) 430-0954
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
11273
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0807673823
—
UT
Enumeration date
11/24/2022
Last updated
11/24/2022
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