Provider Demographics
NPI:1891191664
Name:NEID, JAQUELINE (RD)
Entity Type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:
Last Name:NEID
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-2025
Mailing Address - Country:US
Mailing Address - Phone:801-224-8255
Mailing Address - Fax:801-224-8301
Practice Address - Street 1:1790 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2025
Practice Address - Country:US
Practice Address - Phone:801-224-8255
Practice Address - Fax:801-224-8301
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT90212674901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered