Healthcare Provider Details

I. General information

NPI: 1396991550
Provider Name (Legal Business Name): GINGER ANN BAILEY R.D., C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 S CREEK RD STE 104
SANDY UT
84093-6160
US

IV. Provider business mailing address

1270 W SPRINGSHIRE LN
MURRAY UT
84123-7929
US

V. Phone/Fax

Practice location:
  • Phone: 801-981-8795
  • Fax:
Mailing address:
  • Phone: 801-815-7301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number6784233-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: