Healthcare Provider Details

I. General information

NPI: 1861263451
Provider Name (Legal Business Name): EMILY BEUTLER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3741 W 12600 S
RIVERTON UT
84065-7215
US

IV. Provider business mailing address

729 HYDE PARK CT
PROVO UT
84604-5123
US

V. Phone/Fax

Practice location:
  • Phone: 443-875-3071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number13511740-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: