MEDICARE: PAIGE SMATHERS NUTRITION, LLC

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	1060759	UT

General Provider Information

NPI Number	:	1588159479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIGE SMATHERS NUTRITION, LLC

Provider Business Mailing Address
First Line	:	2936 S HIGHLAND DR STE 100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3584
Country	:	US
Telephone Number	:	801-948-0898
Fax Number	:

Provider Business Practice Location Address
First Line	:	2936 S HIGHLAND DR STE 100
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-3584
Country	:	US
Telephone Number	:	801-948-0898
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PAIGE SMATHERS
Credential	:	RDN
Telephone Number	:	801-948-0898

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	06/25/2018

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