Individual
JENNA WAITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2096 RACHEL DR, SANTA CLARA, UT 84765-5678
(435) 215-3299
Mailing address
2096 RACHEL DR, SANTA CLARA, UT 84765-5678
(435) 215-3299
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
6578247-4901
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6578247-4901
STATE OF UTAH DEPARTMENT OF COMMERCE
UT
01
—
933202
COMMISION ON DIETETIC REGISTRATION (CDR)
—
Enumeration date
01/02/2024
Last updated
01/02/2024
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