Provider Demographics
NPI:1649888108
Name:STRATFORD, ANDREW (RDN)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:STRATFORD
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 S 2130 E
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-5526
Mailing Address - Country:US
Mailing Address - Phone:801-404-8621
Mailing Address - Fax:
Practice Address - Street 1:1137 S 2130 E
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-5526
Practice Address - Country:US
Practice Address - Phone:801-404-8621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86097629133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered