Healthcare Provider Details

I. General information

NPI: 1669164703
Provider Name (Legal Business Name): JOANNE LLAURY-MARKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9235 S REDWASH RD
JENSEN UT
84035-9745
US

IV. Provider business mailing address

PO BOX 480
JENSEN UT
84035-0480
US

V. Phone/Fax

Practice location:
  • Phone: 303-621-6948
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU6151602
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: