Healthcare Provider Details

I. General information

NPI: 1407369630
Provider Name (Legal Business Name): JOSEPH NELSON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 FILLMORE AVE
OGDEN UT
84401
US

IV. Provider business mailing address

PO BOX 57567
MURRAY UT
84157
US

V. Phone/Fax

Practice location:
  • Phone: 800-909-9220
  • Fax: 801-610-6758
Mailing address:
  • Phone: 800-909-9220
  • Fax: 801-610-6758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELINA VIGIL
Title or Position: CREDENTIALING COORD.
Credential:
Phone: 800-909-9220