Healthcare Provider Details

I. General information

NPI: 1558364125
Provider Name (Legal Business Name): NORMAN S NIELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 S 200 W
BLANDING UT
84511-3909
US

IV. Provider business mailing address

799 S 200 W
BLANDING UT
84511-3909
US

V. Phone/Fax

Practice location:
  • Phone: 435-678-3601
  • Fax: 435-678-3610
Mailing address:
  • Phone: 435-678-3601
  • Fax: 435-678-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1670941205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1670941205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: