Healthcare Provider Details

I. General information

NPI: 1215864624
Provider Name (Legal Business Name): MARIAN ISAACSON
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1883 N 1120 W
PROVO UT
84604-1180
US

IV. Provider business mailing address

1063 DOVER DR
PROVO UT
84604-5254
US

V. Phone/Fax

Practice location:
  • Phone: 801-602-2396
  • Fax:
Mailing address:
  • Phone: 801-602-2396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: