Provider Demographics
NPI:1679059265
Name:DAVIS, KATHERINE WETZEL (RDN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:WETZEL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:WETZEL
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN
Mailing Address - Street 1:2332 S 1800 E
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4131
Mailing Address - Country:US
Mailing Address - Phone:801-815-1202
Mailing Address - Fax:
Practice Address - Street 1:2936 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84106-3582
Practice Address - Country:US
Practice Address - Phone:801-385-1709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6379244-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered