Healthcare Provider Details

I. General information

NPI: 1548666019
Provider Name (Legal Business Name): NICHOLAS HUNDLEY CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2014
Last Update Date: 11/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4578 PHEASANT RIDGE TRL
LEHI UT
84043-5027
US

IV. Provider business mailing address

4578 PHEASANT RIDGE TRL
LEHI UT
84043-5027
US

V. Phone/Fax

Practice location:
  • Phone: 412-877-2758
  • Fax:
Mailing address:
  • Phone: 412-877-2758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: