Individual
MADELINE BANTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-5329
Mailing address
865 S AMANDA AVE, SALT LAKE CITY, UT 84105-1625
(801) 755-8056
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
—
ID
Other
Enumeration date
01/30/2017
Last updated
02/02/2022
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