Provider Demographics
NPI:1225541121
Name:WINTER, MARYELIZABETH (MNT)
Entity Type:Individual
Prefix:
First Name:MARYELIZABETH
Middle Name:
Last Name:WINTER
Suffix:
Gender:F
Credentials:MNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3996 E ALPINE VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-6045
Mailing Address - Country:US
Mailing Address - Phone:801-597-0386
Mailing Address - Fax:
Practice Address - Street 1:3996 E ALPINE VALLEY CIR
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84092-6045
Practice Address - Country:US
Practice Address - Phone:801-597-0386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist