Provider Demographics
NPI:1609234996
Name:LOSER NIELSEN, NICHOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:
Last Name:LOSER NIELSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4462 E BRIDLEWAY RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-5874
Mailing Address - Country:US
Mailing Address - Phone:801-472-2493
Mailing Address - Fax:
Practice Address - Street 1:4462 E BRIDLEWAY RD
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5874
Practice Address - Country:US
Practice Address - Phone:801-472-2493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT90948752501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical