Provider Demographics
NPI:1144867664
Name:STEINITZ, TAMARA (RDN, NBC-HWC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:STEINITZ
Suffix:
Gender:F
Credentials:RDN, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 HERITAGE CV
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-3300
Mailing Address - Country:US
Mailing Address - Phone:435-757-5624
Mailing Address - Fax:
Practice Address - Street 1:65 HERITAGE CV
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-3300
Practice Address - Country:US
Practice Address - Phone:435-757-5624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT110294-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered