Provider Demographics
NPI:1013738293
Name:EIXENBERGER, NICHOLAS HEDGES
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:HEDGES
Last Name:EIXENBERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 S WAINWRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-1819
Mailing Address - Country:US
Mailing Address - Phone:801-702-7591
Mailing Address - Fax:
Practice Address - Street 1:672 E VINE ST STE 100
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5539
Practice Address - Country:US
Practice Address - Phone:385-715-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant