Healthcare Provider Details

I. General information

NPI: 1629051206
Provider Name (Legal Business Name): PATRICIA L NELSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 S. FASHION BLVD. STE. 280
MURRAY UT
84107
US

IV. Provider business mailing address

5801 S. FASHION BLVD. STE. 280
MURRAY UT
84107
US

V. Phone/Fax

Practice location:
  • Phone: 801-260-5864
  • Fax: 801-260-5865
Mailing address:
  • Phone: 801-260-5864
  • Fax: 801-260-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number174734-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number174734-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: