Provider Demographics
NPI:1780201293
Name:NICK, HEATHER PATRICIA (MS GC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:PATRICIA
Last Name:NICK
Suffix:
Gender:F
Credentials:MS GC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2138 S PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4111
Mailing Address - Country:US
Mailing Address - Phone:561-801-3984
Mailing Address - Fax:
Practice Address - Street 1:5171 S COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5704
Practice Address - Country:US
Practice Address - Phone:801-507-3983
Practice Address - Fax:801-507-3998
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11794933-3602170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS