Healthcare Provider Details

I. General information

NPI: 1174753305
Provider Name (Legal Business Name): HEALTH & NUTRITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2009
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 SHEPARD LN STE 102
FARMINGTON UT
84025-3934
US

IV. Provider business mailing address

630 SHEPARD LN STE 102
FARMINGTON UT
84025-3934
US

V. Phone/Fax

Practice location:
  • Phone: 801-447-8680
  • Fax: 801-447-4211
Mailing address:
  • Phone: 801-447-8680
  • Fax: 801-447-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number StateUT

VIII. Authorized Official

Name: LISA LARSON
Title or Position: MANAGER
Credential: LMT
Phone: 801-447-8680