Healthcare Provider Details

I. General information

NPI: 1831862309
Provider Name (Legal Business Name): NICOLE PAGE NIELSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7478 S CAMPUS VIEW DR STE 200
WEST JORDAN UT
84084-1969
US

IV. Provider business mailing address

7478 S CAMPUS VIEW DR STE 200
WEST JORDAN UT
84084-1969
US

V. Phone/Fax

Practice location:
  • Phone: 720-955-2105
  • Fax:
Mailing address:
  • Phone: 801-282-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12488179-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: