MEDICARE: RODNEY K NIELSON RN

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
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	7376277-3102	UT

General Provider Information

NPI Number	:	1346591252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODNEY K NIELSON RN

Provider Business Mailing Address
First Line	:	P.O. BOX 4
Second Line	:
City	:	AURORA
State	:	UT
Zip	:	84620
Country	:	US
Telephone Number	:	435-623-1456
Fax Number	:	435-623-1127

Provider Business Practice Location Address
First Line	:	152 NORHT 400 WEST
Second Line	:
City	:	EPHRIAM
State	:	UT
Zip	:	84627-5549
Country	:	US
Telephone Number	:	435-283-8400
Fax Number	:	435-283-8401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2012
Last Update Date	:	10/02/2012

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