Provider Demographics
NPI:1083492540
Name:WHITESIDES, BRITTNI AMBER (RDN)
Entity Type:Individual
Prefix:MRS
First Name:BRITTNI
Middle Name:AMBER
Last Name:WHITESIDES
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 E BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3659
Mailing Address - Country:US
Mailing Address - Phone:801-819-6499
Mailing Address - Fax:
Practice Address - Street 1:2316 E BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84124-3659
Practice Address - Country:US
Practice Address - Phone:801-819-6499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13553319-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered