Healthcare Provider Details

I. General information

NPI: 1205492006
Provider Name (Legal Business Name): STORMEY NIELSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 S FASHION BLVD STE 200
MURRAY UT
84107-6162
US

IV. Provider business mailing address

1160 E MURRAY HOLLADAY RD
SALT LAKE CITY UT
84117-4927
US

V. Phone/Fax

Practice location:
  • Phone: 385-347-0904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11275791-3501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: