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NPI Code Detail

MEDICARE: DR. VANESSA B NIELSEN PHARMD

MEDICARE: DR. VANESSA B NIELSEN PHARMD
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
11835P2201XAmbulatory Care Pharmacist357685-1701UT

General Provider Information

NPI Number : 1194268466
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VANESSA B NIELSEN PHARMD
Provider Business Mailing Address
First Line : 10214 S MYSTIC CREEK BAY
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-4698
Country : US
Telephone Number : 801-450-8248
Fax Number :
Provider Business Practice Location Address
First Line : 615 S ARAPEEN DR STE 100
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-1239
Country : US
Telephone Number : 801-587-3934
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2016
Last Update Date : 11/18/2016

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