Provider Demographics
NPI:1780221390
Name:DAVIS, EMILIE (MS)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 E DRY CREEK RIDGE LN UNIT B119
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3936
Mailing Address - Country:US
Mailing Address - Phone:801-995-2731
Mailing Address - Fax:
Practice Address - Street 1:347 N 300 W STE 203
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1828
Practice Address - Country:US
Practice Address - Phone:801-593-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education