MEDICARE: BRADLEY P NIELSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	2373399-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457359317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY P NIELSEN

Provider Business Mailing Address
First Line	:	1954 FORT UNION BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6800
Country	:	US
Telephone Number	:	801-993-9530
Fax Number	:	801-733-5618

Provider Business Practice Location Address
First Line	:	1954 FORT UNION BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6800
Country	:	US
Telephone Number	:	801-993-9530
Fax Number	:	801-733-5618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/11/2007

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Directions to “ BRADLEY P NIELSEN ” Practice Location

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