Provider Demographics
NPI:1558627620
Name:ERNST, SHARON LOUISE (RD, CSP)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LOUISE
Last Name:ERNST
Suffix:
Gender:F
Credentials:RD, CSP
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:L
Other - Last Name:ERNST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CD
Mailing Address - Street 1:50 N MARIO CAPECCHI DR
Mailing Address - Street 2:RM 2C412, SOM
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0001
Mailing Address - Country:US
Mailing Address - Phone:801-581-8738
Mailing Address - Fax:801-587-7690
Practice Address - Street 1:100 MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1057704901133V00000X
501004133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric