Provider Demographics
NPI:1790353266
Name:BEUTLER, LAUREN (RD, CD)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:
Last Name:BEUTLER
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 W 1100 N APT 1
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2489
Mailing Address - Country:US
Mailing Address - Phone:208-431-0416
Mailing Address - Fax:
Practice Address - Street 1:345 W 1100 N APT 1
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2489
Practice Address - Country:US
Practice Address - Phone:208-431-0416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA