MEDICARE: DAKOTA WREN CHETRIT PA-C, RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1036816	CA
2	207Q00000X	Family Medicine Physician	8668423-1206	UT

General Provider Information

NPI Number	:	1043541584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAKOTA WREN CHETRIT PA-C, RD

Provider Business Mailing Address
First Line	:	3913 BOYLE CT
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	565 S KOMAS DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1208
Country	:	US
Telephone Number	:	801-584-5144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2010
Last Update Date	:	11/26/2019

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