Healthcare Provider Details

I. General information

NPI: 1811773054
Provider Name (Legal Business Name): KENDAL LENA BJELLA RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KENDAL LENA CHRISTENSEN

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 S 900 E
SALT LAKE CITY UT
84102-2310
US

IV. Provider business mailing address

PO BOX 30180
SALT LAKE CITY UT
84130-0180
US

V. Phone/Fax

Practice location:
  • Phone: 385-282-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number9379347-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: