Provider Demographics
NPI:1316184930
Name:ISAACSON, NINA (MSOM, LAC)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:ISAACSON
Suffix:
Gender:F
Credentials:MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 S SETTLEMENT DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:UT
Mailing Address - Zip Code:84653-2000
Mailing Address - Country:US
Mailing Address - Phone:801-376-4527
Mailing Address - Fax:
Practice Address - Street 1:800 N 100 E
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-5577
Practice Address - Country:US
Practice Address - Phone:801-376-4527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7206045-1201171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist