Provider Demographics
NPI:1346521986
Name:LUND, TERI (RD, CD)
Entity type:Individual
Prefix:MRS
First Name:TERI
Middle Name:
Last Name:LUND
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 1:1160 E 3900 S STE G100
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1202
Mailing Address - Country:US
Mailing Address - Phone:801-268-7479
Mailing Address - Fax:801-268-7622
Practice Address - Street 1:1160 E 3900 S STE G100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1202
Practice Address - Country:US
Practice Address - Phone:801-268-7479
Practice Address - Fax:801-268-7622
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7796269-4901133V00000X
UT1038902133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered