Healthcare Provider Details

I. General information

NPI: 1134357239
Provider Name (Legal Business Name): MARSHALL NICKEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 W 9000 S
WEST JORDAN UT
84088-5610
US

IV. Provider business mailing address

3181 W 9000 S
WEST JORDAN UT
84088-5610
US

V. Phone/Fax

Practice location:
  • Phone: 801-569-5600
  • Fax:
Mailing address:
  • Phone: 801-569-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60216841
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2011-01336
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-13326
License Number StateID
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9849340-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: