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General NPI Number Information
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NPI Number | 1447455167
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Entity Type | Organization
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Legal Business Name | NEBO FOOT & ANKLE LLC
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 65 W 200 N SUITE 1
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City | SPANISH FORK
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State | UT
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Zip | 84660-1756
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Country | US
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Telephone | 801-794-3856
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Fax | 801-794-9882
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Provider Business Mailing Address
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Address Line | 65 W 200 N STE 5
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City | SPANISH FORK
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State | UT
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Zip | 84660-1774
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Country | US
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Telephone | 801-794-3856
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Fax | 801-794-9882
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL L NELSON
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Credential | DPM
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Telephone | 801-794-3856
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 367775-0501
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License Number State | UT
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