Provider Demographics
NPI:1598024119
Name:ISABELLA, PATRICE H (RD)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:H
Last Name:ISABELLA
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 1:1448 BRYAN AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2650
Mailing Address - Country:US
Mailing Address - Phone:801-718-2997
Mailing Address - Fax:
Practice Address - Street 1:1448 BRYAN AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2650
Practice Address - Country:US
Practice Address - Phone:801-718-2997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT104691-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered