Provider Demographics
NPI:1659981678
Name:REICHNER, KIRSTEN TARA MARQUIS (RDN)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:TARA MARQUIS
Last Name:REICHNER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 E 680 N
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1417
Mailing Address - Country:US
Mailing Address - Phone:801-372-5538
Mailing Address - Fax:
Practice Address - Street 1:322 E 680 N
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1417
Practice Address - Country:US
Practice Address - Phone:801-372-5538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86114058133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered