Healthcare Provider Details

I. General information

NPI: 1447455167
Provider Name (Legal Business Name): NEBO FOOT & ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 W 200 N SUITE 1
SPANISH FORK UT
84660-1756
US

IV. Provider business mailing address

65 W 200 N STE 5
SPANISH FORK UT
84660-1774
US

V. Phone/Fax

Practice location:
  • Phone: 801-794-3856
  • Fax: 801-794-9882
Mailing address:
  • Phone: 801-794-3856
  • Fax: 801-794-9882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number367775-0501
License Number StateUT

VIII. Authorized Official

Name: MICHAEL L NELSON
Title or Position: OWNER
Credential: DPM
Phone: 801-794-3856