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General NPI Number Information
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NPI Number | 1760596225
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Entity Type | Individual
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Provider Name | LINDA SMITH NILSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 415 MEDICAL DR #D - 101
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City | BOUNTIFUL
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State | UT
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Zip | 84010-4946
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Country | US
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Telephone | 801-298-2332
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Fax | 801-298-5018
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Provider Business Mailing Address
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Address Line | 573 WEST 1890 NORTH
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City | WEST BOUNTIFUL
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State | UT
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Zip | 84087-1156
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Country | US
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Telephone | 801-298-5652
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 196314-4405
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License Number State | UT
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