Healthcare Provider Details

I. General information

NPI: 1720252513
Provider Name (Legal Business Name): KANDICE ROSE NIELSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4403 HARRISON BLVD STE 4815
OGDEN UT
84403-3333
US

IV. Provider business mailing address

PO BOX 27128 STE 340
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-8350
  • Fax: 801-387-8355
Mailing address:
  • Phone: 801-706-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number829812-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: