Provider Demographics
NPI:1124824305
Name:HUNTER, MILLIE MICHELLE (MDA, RD, CD)
Entity type:Individual
Prefix:MRS
First Name:MILLIE
Middle Name:MICHELLE
Last Name:HUNTER
Suffix:
Gender:
Credentials:MDA, RD, CD
Other - Prefix:
Other - First Name:MILLIE
Other - Middle Name:MICHELLE
Other - Last Name:KILLION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:575 S FREEDOM BLVD APT 222
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-4579
Mailing Address - Country:US
Mailing Address - Phone:817-507-7397
Mailing Address - Fax:
Practice Address - Street 1:1790 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2025
Practice Address - Country:US
Practice Address - Phone:801-224-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86314719133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered