Provider Demographics
NPI:1487688081
Name:GILGEN, EMILY CANNON (RD, CDE)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:CANNON
Last Name:GILGEN
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:A
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD CD
Mailing Address - Street 1:1200 E 3900 S
Mailing Address - Street 2:NMOB 3300
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1300
Mailing Address - Country:US
Mailing Address - Phone:801-268-7931
Mailing Address - Fax:801-270-3318
Practice Address - Street 1:1200 E 3900 S
Practice Address - Street 2:NMOB 3300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1300
Practice Address - Country:US
Practice Address - Phone:801-268-7931
Practice Address - Fax:801-270-3318
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA952619133V00000X
UT6725542-4901133VN1006X
UT20810055174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator