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General NPI Number Information
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NPI Number | 1669164703
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Entity Type | Individual
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Provider Name | JOANNE LLAURY-MARKS
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Gender | Female
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Dates
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Enumeration Date | 05/25/2023
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 9235 S REDWASH RD
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City | JENSEN
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State | UT
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Zip | 84035-9745
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Country | US
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Telephone | 303-621-6948
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 480
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City | JENSEN
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State | UT
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Zip | 84035-0480
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Country | US
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Telephone |
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | NU6151602
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License Number State | WA
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