Provider Demographics
NPI:1720489842
Name:UNDERWOOD, TERI (RD, MS, CD)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:RD, MS, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9475 SILVER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5645
Mailing Address - Country:US
Mailing Address - Phone:801-831-6967
Mailing Address - Fax:435-658-0013
Practice Address - Street 1:700 BITNER RD
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5489
Practice Address - Country:US
Practice Address - Phone:801-831-6967
Practice Address - Fax:435-658-0013
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT109733-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered