Provider Demographics
NPI:1699318170
Name:OAR, ARYANE MENDES ANDRADE (RD)
Entity type:Individual
Prefix:
First Name:ARYANE
Middle Name:MENDES ANDRADE
Last Name:OAR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 E CRANDALL AVE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4471
Mailing Address - Country:US
Mailing Address - Phone:541-231-6615
Mailing Address - Fax:
Practice Address - Street 1:2936 S HIGHLAND DR STE 100
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-3584
Practice Address - Country:US
Practice Address - Phone:385-831-1709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11479422-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered