Doctor Name: | DR. NICHOLE LOSER NIELSEN |
NPI Number: | 1609234996 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 90948752501 |
Business Practice Address: | 4462 E Bridleway Rd Eagle Mountain, UT - 840055874 |
Business Phone Number: | 8014722493 |
Business Fax Number: | |
Mailing Address: | 4462 E Bridleway Rd, EAGLE MOUNTAIN |
State: | UT |
Postal Code: | 840055874 |
Phone Number: | 8014722493 |
Fax Number: | |
NPI Enumeration Date: | 02/02/2016 |
NPI Last Update Date: | 02/02/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 90948752501 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |