Healthcare Provider Details

I. General information

NPI: 1578364725
Provider Name (Legal Business Name): NATALIE DIANE NAVESTAD MS, RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE DIANE KERRIGAN MS, RD, CD

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 HARRISON BLVD
OGDEN UT
84403-3195
US

IV. Provider business mailing address

132 N 475 E
LAYTON UT
84041-3222
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-2000
  • Fax:
Mailing address:
  • Phone: 570-472-7579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86326198
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: