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NPI Code Detail

MEDICARE: ANDREA WALSH MS, RDN

MEDICARE: ANDREA WALSH MS, RDN
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
1133V00000XRegistered Dietitian

General Provider Information

NPI Number : 1467112136
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA WALSH MS, RDN
Provider Business Mailing Address
First Line : 8614 S SCOTTISH DR
Second Line :
City : SANDY
State : UT
Zip : 84093-2132
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2319 S FOOTHILL DR STE 180
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84109-5403
Country : US
Telephone Number : 801-518-0136
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2021
Last Update Date : 12/22/2021

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