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General NPI Number Information
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NPI Number | 1134357239
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Entity Type | Individual
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Provider Name | MARSHALL NICKEL MD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 3181 W 9000 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-5610
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Country | US
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Telephone | 801-569-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 3181 W 9000 S
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City | WEST JORDAN
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State | UT
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Zip | 84088-5610
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Country | US
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Telephone | 801-569-5600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD60216841
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2011-01336
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M-13326
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 9849340-1205
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License Number State | UT
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