Provider Demographics
NPI:1528517703
Name:NIELSEN, REBECCA RAE
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:RAE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 N 500 E
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-4124
Mailing Address - Country:US
Mailing Address - Phone:801-722-9491
Mailing Address - Fax:
Practice Address - Street 1:456 N 500 E
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4124
Practice Address - Country:US
Practice Address - Phone:801-722-9491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver