Basic Information
| Provider Information | |||||||||
| NPI: | 1649698820 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, RD, CD, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 253 W 1900 S | ||||||||
| Address2: | |||||||||
| City: | CLEARFIELD | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840154310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017759819 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 W ANTELOPE DR | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018071000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2014 | ||||||||
| LastUpdateDate: | 04/03/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 5245302-4901 | UT | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.