MEDICARE: EMILY ELTON WEAVER

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	7751775-4901	UT

General Provider Information

NPI Number	:	1073439154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ELTON WEAVER

Provider Business Mailing Address
First Line	:	1840 E WILD WILLOW LN
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-1478
Country	:	US
Telephone Number	:	801-507-4945
Fax Number	:	801-507-4806

Provider Business Practice Location Address
First Line	:	5169 S COTTONWOOD ST STE 310
Second Line	:
City	:	MURRAY
State	:	UT
Zip	:	84107-6768
Country	:	US
Telephone Number	:	801-507-4945
Fax Number	:	801-507-4806

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

Provider Enumeration Date	:	06/24/2026
Last Update Date	:	06/24/2026

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Directions to “ EMILY ELTON WEAVER ” Practice Location

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