Individual
ISABELL ANN NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
69 N MAIN ST APT B215, CLEARFIELD, UT 84015-2584
(775) 453-3479
Mailing address
69 N MAIN ST APT B215, CLEARFIELD, UT 84015-2584
(775) 453-3479
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
12178099-4701
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12178099-4701
DOPL
UT
Enumeration date
07/26/2021
Last updated
07/26/2021
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