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NPI Code Detail

MEDICARE: MRS. ADRIENNE NIELSEN

MEDICARE: MRS. ADRIENNE NIELSEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124662424
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ADRIENNE NIELSEN
Provider Business Mailing Address
First Line : 1129 S 1000 E APT 3
Second Line :
City : PROVO
State : UT
Zip : 84606-5078
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6910 S HIGHLAND DR STE 1
Second Line :
City : COTTONWOOD HEIGHTS
State : UT
Zip : 84121-3061
Country : US
Telephone Number : 801-222-2222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2019
Last Update Date : 10/30/2019

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Directions to “ MRS. ADRIENNE NIELSEN ” Practice Location

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