Healthcare Provider Details

I. General information

NPI: 1467216697
Provider Name (Legal Business Name): CAMILLE SATTERTHWAITE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E MOVIE RANCH ROAD
DUCK CREEK VILLAGE UT
84762-8476
US

IV. Provider business mailing address

HC 82 BOX 2203
DUCK CREEK VILLAGE UT
84762-8212
US

V. Phone/Fax

Practice location:
  • Phone: 801-547-7718
  • Fax:
Mailing address:
  • Phone: 801-547-7718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number9393369-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: