Most Relevant Information
Provider Data
| NPI Number: | 1003345141 |
| Provider Name: | NICHOLE CHALISE NELSON FNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 84056654405 |
Most Important Dates
| Enumeration Date: | 06/11/2017 |
| Last Updated: | 06/11/2017 |
Provider Practice Location
1446 W PLEASANT GROVE BLVD
PLEASANT GROVE
UT
840623216
Practice Location Phone/Fax
| Phone: | |
| Fax: |
Provider Mailing Location
75 S 500 W
SALEM
UT
846539304
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |