Provider Demographics
NPI:1942510789
Name:SORENSON, MARILYN LUCILLE (RDN, CD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:LUCILLE
Last Name:SORENSON
Suffix:
Gender:F
Credentials:RDN, CD
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:
Other - Last Name:SORENON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN, CD
Mailing Address - Street 1:463 E RUBY PL
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-2838
Mailing Address - Country:US
Mailing Address - Phone:509-315-7815
Mailing Address - Fax:
Practice Address - Street 1:652 S MEDICAL CENTER DR LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7049
Practice Address - Country:US
Practice Address - Phone:435-251-3793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60131549133V00000X
UT9722341-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered