Individual
CASEY MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, IBCLC
Contact information
Practice address
4765 N GRANDVIEW PEAK DR, EAGLE MOUNTAIN, UT 84005-5440
(480) 393-9933
Mailing address
4765 N GRANDVIEW PEAK DR, EAGLE MOUNTAIN, UT 84005-5440
(480) 393-9933
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1090229
—
174N00000X
Lactation Consultant (Non-RN)
L-315224
—
Other
Enumeration date
06/28/2024
Last updated
06/28/2024
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