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NPI Code Detail

MEDICARE: BETTY B WADE DIETITIAN

MEDICARE: BETTY B WADE DIETITIAN
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 Dietitian106187-4901UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11061874901OTHERUTUTAH STATE LICENSE

General Provider Information

NPI Number : 1528079449
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETTY B WADE DIETITIAN
Provider Business Mailing Address
First Line : PO BOX 30180
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84130-0180
Country : US
Telephone Number :
Fax Number : 801-357-7997
Provider Business Practice Location Address
First Line : 454 E MEDICAL WAY
Second Line :
City : HEBER CITY
State : UT
Zip : 84032-1391
Country : US
Telephone Number : 435-658-6738
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2006
Last Update Date : 01/29/2026

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Directions to “ BETTY B WADE DIETITIAN” Practice Location

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