Individual
MR. UAISELE FORREST PANISI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1525 W 2100 S, SALT LAKE CITY, UT 84119-1401
(801) 213-9900
Mailing address
127 S 500 E, SUITE 140, SLC, UT 84102-1959
(801) 587-6308
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
379299-1206
UT
363AM0700X
Medical Physician Assistant
Primary
379299-1206
UT
Other
Enumeration date
10/21/2008
Last updated
03/21/2018
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