Provider Demographics
NPI:1619652310
Name:MELANIE NIELSEN PMHNP PLLC
Entity Type:Organization
Organization Name:MELANIE NIELSEN PMHNP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:801-513-5694
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:801-513-5694
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty