Provider Demographics
NPI:1699776922
Name:NIELSON, JOSHUA HINCKLEY (DO)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:HINCKLEY
Last Name:NIELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA CREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84534-0130
Mailing Address - Country:US
Mailing Address - Phone:435-651-3700
Mailing Address - Fax:435-651-3376
Practice Address - Street 1:1478 EAST HIGHWAY 162
Practice Address - Street 2:
Practice Address - City:MONTEZUMA CREEK
Practice Address - State:UT
Practice Address - Zip Code:84534-0130
Practice Address - Country:US
Practice Address - Phone:435-651-3700
Practice Address - Fax:435-678-0707
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6681743-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03877361Medicaid
AZ314499Medicaid
CO17532353Medicaid
8HH587Medicare PIN
320059Medicare Oscar/Certification
8HH587Medicare PIN