Provider Demographics
NPI:1982905386
Name:ALDOUS, ADRIENNE (PHD RD)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:ALDOUS
Suffix:
Gender:F
Credentials:PHD RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3762 EASTCLIFF CIR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3872
Mailing Address - Country:US
Mailing Address - Phone:801-278-9571
Mailing Address - Fax:801-278-9386
Practice Address - Street 1:3762 EASTCLIFF CIR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3872
Practice Address - Country:US
Practice Address - Phone:801-278-9571
Practice Address - Fax:801-278-9386
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT713828133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered