Provider Demographics
NPI:1215332929
Name:MANWILL, KENDRA (RD, CD)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:MANWILL
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 N 800 E
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3369
Mailing Address - Country:US
Mailing Address - Phone:385-329-8459
Mailing Address - Fax:
Practice Address - Street 1:1661 N 800 E
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-3369
Practice Address - Country:US
Practice Address - Phone:385-329-8459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT90839944901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86011527OtherCOMMISSION ON DIETETIC REGISTRATION
UT9083994-4901OtherSTATE OF UTAH DOPL CERTIFICATION