Provider Demographics
NPI:1346591252
Name:NIELSON, RODNEY K (RN)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:K
Last Name:NIELSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 4
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:UT
Mailing Address - Zip Code:84620
Mailing Address - Country:US
Mailing Address - Phone:435-623-1456
Mailing Address - Fax:435-623-1127
Practice Address - Street 1:152 NORHT 400 WEST
Practice Address - Street 2:
Practice Address - City:EPHRIAM
Practice Address - State:UT
Practice Address - Zip Code:84627-5549
Practice Address - Country:US
Practice Address - Phone:435-283-8400
Practice Address - Fax:435-283-8401
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7376277-3102163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health