Provider Demographics
NPI:1992884308
Name:MCISAAC, NANCY JANE (LMT, NCTMB, MMP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:JANE
Last Name:MCISAAC
Suffix:
Gender:F
Credentials:LMT, NCTMB, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E 12450 S
Mailing Address - Street 2:SUITE #204
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8058
Mailing Address - Country:US
Mailing Address - Phone:801-576-1220
Mailing Address - Fax:
Practice Address - Street 1:114 E 12450 S
Practice Address - Street 2:SUITE #204
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8058
Practice Address - Country:US
Practice Address - Phone:801-576-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT371318-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist