Individual
SARA MARIE MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D., M.B.A.
Contact information
Practice address
1990 S MCCLELLAND ST APT 15, SALT LAKE CITY, UT 84105-3456
(310) 529-2455
Mailing address
1990 S MCCLELLAND ST APT 15, SALT LAKE CITY, UT 84105-3456
(310) 529-2455
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1062741
UT
Other
Enumeration date
09/05/2013
Last updated
09/05/2013
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