MEDICARE: JENNIFER SCHMIDT RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1089855	UT

General Provider Information

NPI Number	:	1073282349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SCHMIDT RD

Provider Business Mailing Address
First Line	:	3662 E KAIBAB CIR
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84109-2309
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3662 E KAIBAB CIR
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84109-2309
Country	:	US
Telephone Number	:	801-550-5978
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2021
Last Update Date	:	09/09/2021

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