Provider Demographics
NPI:1104460567
Name:GUENTHER, PATRICIA MAXINE (PHD, RD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MAXINE
Last Name:GUENTHER
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 1:16 E CHURCHILL DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2266
Mailing Address - Country:US
Mailing Address - Phone:801-449-0726
Mailing Address - Fax:
Practice Address - Street 1:16 E CHURCHILL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2266
Practice Address - Country:US
Practice Address - Phone:801-449-0726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered