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NPI Code Detail

MEDICARE: JARED NIELSEN PA-C

MEDICARE:   JARED  NIELSEN  PA-C
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
1363A00000XPhysician Assistant13111589-1206UT

General Provider Information

NPI Number : 1932835311
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARED NIELSEN PA-C
Provider Business Mailing Address
First Line : 985 LILLYWOOD LN
Second Line :
City : NORTH SALT LAKE
State : UT
Zip : 84054-3054
Country : US
Telephone Number : 801-915-3989
Fax Number :
Provider Business Practice Location Address
First Line : 985 LILLYWOOD LN
Second Line :
City : NORTH SALT LAKE
State : UT
Zip : 84054-3054
Country : US
Telephone Number : 801-915-3989
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2022
Last Update Date : 11/09/2022

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Directions to “ JARED NIELSEN PA-C” Practice Location

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