Provider Demographics
NPI:1407643018
Name:PANZERI, TABITHA DANETTE (RDN, LD)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:DANETTE
Last Name:PANZERI
Suffix:
Gender:
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3031
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84409-1031
Mailing Address - Country:US
Mailing Address - Phone:601-618-7693
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 3031
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84409-1031
Practice Address - Country:US
Practice Address - Phone:601-618-7693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14210681-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered