Provider Demographics
NPI:1427570118
Name:NIELSEN, MELANIE (MSN, RN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MSN, RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 N 300 W STE 501
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1881
Mailing Address - Country:US
Mailing Address - Phone:801-513-5894
Mailing Address - Fax:385-284-0322
Practice Address - Street 1:283 N 300 W STE 501
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1881
Practice Address - Country:US
Practice Address - Phone:801-513-5694
Practice Address - Fax:385-284-0322
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-13
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134447363LP0808X
UT7236676-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health