Healthcare Provider Details

I. General information

NPI: 1689003469
Provider Name (Legal Business Name): REBECCA HURST DAVIS MS,RD,CSP,CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1125
US

IV. Provider business mailing address

81 N MARIO CAPECCHI DR
SALT LAKE CITY UT
84113-1125
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-5325
  • Fax:
Mailing address:
  • Phone: 801-662-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number353807-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: