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General NPI Number Information
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NPI Number | 1083867931
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Entity Type | Individual
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Provider Name | SUZANNE O WARE RD
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Gender | Female
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 85 MEDICAL DR # 201
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City | SALT LAKE CITY
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State | UT
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Zip | 84112-1100
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Country | US
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Telephone | 801-581-8578
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Fax |
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Provider Business Mailing Address
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Address Line | 85 MEDICAL DR # 201
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City | SALT LAKE CITY
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State | UT
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Zip | 84112-1100
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Country | US
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Telephone | 801-581-8578
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1005X
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Taxonomy Name | Renal Nutrition Registered Dietitian
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License Number | 100242-4901
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License Number State | UT
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