Healthcare Provider Details

I. General information

NPI: 1154383206
Provider Name (Legal Business Name): CAROLYN LOUISE ANICH A.P.R.N., PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 FOOTHILL BLVD
SALT LAKE CITY UT
84148-0001
US

IV. Provider business mailing address

2180 E 900 S
SALT LAKE CITY UT
84108-1462
US

V. Phone/Fax

Practice location:
  • Phone: 801-582-1565
  • Fax: 801-584-2519
Mailing address:
  • Phone: 801-582-1565
  • Fax: 801-584-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number201917-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: