Individual
SHANNON MARY BARHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
270 N 1080 E, PROVO, UT 84606-3518
(385) 539-2122
Mailing address
270 N 1080 E, PROVO, UT 84606-3518
(385) 539-2122
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
13196645-4901
UT
Other
Enumeration date
03/24/2023
Last updated
03/24/2023
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