Healthcare Provider Details

I. General information

NPI: 1861151243
Provider Name (Legal Business Name): ERIN OGDEN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 ESTHER CT
CONWAY SC
29526-8115
US

IV. Provider business mailing address

809 ESTHER CT
CONWAY SC
29526-8115
US

V. Phone/Fax

Practice location:
  • Phone: 253-486-6296
  • Fax:
Mailing address:
  • Phone: 253-486-6296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number10464096-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: