Healthcare Provider Details

I. General information

NPI: 1538299169
Provider Name (Legal Business Name): CHERYL A MINOR C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1686 SPRING CREEK DR
SPRINGVILLE UT
84663-2124
US

IV. Provider business mailing address

1034 N 500 W
PROVO UT
84604-3380
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-7159
  • Fax:
Mailing address:
  • Phone: 801-357-2940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number102194-4901
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: