Provider Demographics
NPI:1093328551
Name:ROWLEY, COREY MARNIE (RDN)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:MARNIE
Last Name:ROWLEY
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 1:260 S 500 E APT 301
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3779
Mailing Address - Country:US
Mailing Address - Phone:301-919-7421
Mailing Address - Fax:
Practice Address - Street 1:2180 E 4500 S STE 265
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4024
Practice Address - Country:US
Practice Address - Phone:801-218-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86145810133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered