Provider Demographics
NPI:1477027340
Name:CHRISTENSEN, MARISA (BS, RDN, CPT)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:BS, RDN, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9270 N 6800 W
Mailing Address - Street 2:
Mailing Address - City:TREMONTON
Mailing Address - State:UT
Mailing Address - Zip Code:84337-8605
Mailing Address - Country:US
Mailing Address - Phone:435-279-4863
Mailing Address - Fax:
Practice Address - Street 1:2548 W 940 N
Practice Address - Street 2:
Practice Address - City:TREMONTON
Practice Address - State:UT
Practice Address - Zip Code:84337-9396
Practice Address - Country:US
Practice Address - Phone:435-279-4863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11125361-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered