1255688685 NPI number — AMELIA BETH DAVIDSON MS, RD, CSP, CD

Table of content: AMELIA BETH DAVIDSON MS, RD, CSP, CD (NPI 1255688685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255688685 NPI number — AMELIA BETH DAVIDSON MS, RD, CSP, CD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIDSON
Provider First Name:
AMELIA
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, RD, CSP, CD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCBRIDE
Provider Other First Name:
AMELIA
Provider Other Middle Name:
BETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, RD, CSP, CD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255688685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MARIO CAPECCHI DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84113-1103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-662-5320
Provider Business Mailing Address Fax Number:
801-662-5300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MARIO CAPECCHI DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84113-1103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-662-5320
Provider Business Practice Location Address Fax Number:
801-662-5300
Provider Enumeration Date:
08/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133VN1004X , with the licence number:  6349146-4901 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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