Provider Demographics
NPI:1013237502
Name:NIELSEN, CURTIS A (DO)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:A
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 N CENTER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7498
Mailing Address - Country:US
Mailing Address - Phone:801-753-7770
Mailing Address - Fax:801-753-7775
Practice Address - Street 1:3401 N CENTER ST STE 100
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-7498
Practice Address - Country:US
Practice Address - Phone:801-753-7770
Practice Address - Fax:801-753-7775
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8063548-1204207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty