Healthcare Provider Details

I. General information

NPI: 1043133523
Provider Name (Legal Business Name): BOBBIE JO NIELSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2381 N 4425 W
PLAIN CITY UT
84404-9678
US

IV. Provider business mailing address

2381 N 4425 W
PLAIN CITY UT
84404-9678
US

V. Phone/Fax

Practice location:
  • Phone: 801-391-5620
  • Fax:
Mailing address:
  • Phone: 801-391-5620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: