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General NPI Number Information
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NPI Number | 1629035795
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Entity Type | Individual
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Provider Name | GARY E NELSON PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 01/02/2013
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Provider Practice Location Address
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Address Line | 150 E CENTER ST SUITE 1100
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City | PROVO
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State | UT
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Zip | 84606-3106
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Country | US
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Telephone | 801-374-7011
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Fax | 801-374-7009
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Provider Business Mailing Address
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Address Line | 150 E CENTER ST SUITE 1100
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City | PROVO
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State | UT
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Zip | 84606-3106
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Country | US
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Telephone | 801-374-7011
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Fax | 801-374-7009
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 105991-1206
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License Number State | UT
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