Healthcare Provider Details

I. General information

NPI: 1265204903
Provider Name (Legal Business Name): CHRISTEN ANNE LIM ANIEL RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 FOOTHILL BLVD STE 100
SALT LAKE CITY UT
84113-1106
US

IV. Provider business mailing address

52 S 980 W
OREM UT
84058-5204
US

V. Phone/Fax

Practice location:
  • Phone: 801-924-6818
  • Fax: 801-924-6811
Mailing address:
  • Phone: 904-510-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number136010494901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: