Doctor Name: | ANDREA ADDLEY |
NPI Number: | 1013255066 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 6511772-4901 |
Business Practice Address: | 1174 E Graystone Way Ste 1a Salt Lake City, UT - 841062671 |
Business Phone Number: | 8016642182 |
Business Fax Number: | |
Mailing Address: | 2542 W 2800 S, WESTON |
State: | ID |
Postal Code: | 832865125 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 01/26/2013 |
NPI Last Update Date: | 01/26/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133V00000X |
License Number: | 6511772-4901 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | |
Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |