Provider Demographics
NPI:1881036820
Name:POULSON, BRITTANY J (RDN, CD, CDCES)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:J
Last Name:POULSON
Suffix:
Gender:F
Credentials:RDN, CD, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1171
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84029-1171
Mailing Address - Country:US
Mailing Address - Phone:435-277-0611
Mailing Address - Fax:
Practice Address - Street 1:102 MARCIANO WAY
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84029-5575
Practice Address - Country:US
Practice Address - Phone:435-277-0611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1034638133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered