Provider Demographics
NPI:1760596225
Name:NILSON, LINDA SMITH (FNP-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SMITH
Last Name:NILSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 WEST 1890 NORTH
Mailing Address - Street 2:
Mailing Address - City:WEST BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84087-1156
Mailing Address - Country:US
Mailing Address - Phone:801-298-5652
Mailing Address - Fax:
Practice Address - Street 1:415 MEDICAL DR
Practice Address - Street 2:#D - 101
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4946
Practice Address - Country:US
Practice Address - Phone:801-298-2332
Practice Address - Fax:801-298-5018
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT196314-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily