Provider Demographics
NPI:1821870312
Name:PINCOCK, MARISA (RDN)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:PINCOCK
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 1:721 N 780 E
Mailing Address - Street 2:
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-2559
Mailing Address - Country:US
Mailing Address - Phone:806-392-6882
Mailing Address - Fax:
Practice Address - Street 1:721 N 780 E
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-2559
Practice Address - Country:US
Practice Address - Phone:806-392-6882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86198043133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered