Healthcare Provider Details

I. General information

NPI: 1306754668
Provider Name (Legal Business Name): NICOLE PETO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5290 S 400 E
OGDEN UT
84405-7194
US

IV. Provider business mailing address

1134 S 4650 W
WEST POINT UT
84015-4700
US

V. Phone/Fax

Practice location:
  • Phone: 801-476-1777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number9654341-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: