Provider Demographics
NPI:1467133512
Name:HAROLDSEN, KENIA NICOLE (RD)
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:NICOLE
Last Name:HAROLDSEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:862 E SOUTHLAKE DR APT 17C
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5349
Mailing Address - Country:US
Mailing Address - Phone:559-305-4204
Mailing Address - Fax:
Practice Address - Street 1:498 N 900 W
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-4137
Practice Address - Country:US
Practice Address - Phone:559-305-4204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered