Provider Demographics
NPI:1255006946
Name:PRINCE, NANCY E (LMT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:E
Last Name:PRINCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 N 100 E STE A
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1904
Mailing Address - Country:US
Mailing Address - Phone:801-897-8711
Mailing Address - Fax:385-333-7202
Practice Address - Street 1:186 N 100 E STE A
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1904
Practice Address - Country:US
Practice Address - Phone:801-897-8711
Practice Address - Fax:385-333-7202
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7760739-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist