Provider Demographics
NPI:1962070615
Name:NELSON, RUBY SUE (APRN)
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:SUE
Last Name:NELSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 E 100 S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651
Mailing Address - Country:US
Mailing Address - Phone:801-382-9338
Mailing Address - Fax:801-382-0246
Practice Address - Street 1:95 S 100 E STE 300
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2253
Practice Address - Country:US
Practice Address - Phone:801-832-9338
Practice Address - Fax:801-832-0246
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT202451-3102163WP0809X
390200000X
UT202451-8900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program