Provider Demographics
NPI:1235830415
Name:LAMB, JACOB W (RDN)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:W
Last Name:LAMB
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2836 S 50 W
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6407
Mailing Address - Country:US
Mailing Address - Phone:385-382-0820
Mailing Address - Fax:
Practice Address - Street 1:2836 S 50 W
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6407
Practice Address - Country:US
Practice Address - Phone:385-382-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12803458-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered