Provider Demographics
NPI:1659138212
Name:UNSWORTH, ANIKA BRYNN ISOM
Entity Type:Individual
Prefix:
First Name:ANIKA
Middle Name:BRYNN ISOM
Last Name:UNSWORTH
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 1:1188 UNIVERSITY VLG
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84108-3505
Mailing Address - Country:US
Mailing Address - Phone:435-890-4773
Mailing Address - Fax:
Practice Address - Street 1:1188 UNIVERSITY VLG
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84108-3505
Practice Address - Country:US
Practice Address - Phone:435-890-4773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program