Provider Demographics
NPI:1861963456
Name:MOORE, CHELSIE STEGEMILLER (CNS)
Entity type:Individual
Prefix:
First Name:CHELSIE
Middle Name:STEGEMILLER
Last Name:MOORE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3607
Mailing Address - Country:US
Mailing Address - Phone:530-307-9789
Mailing Address - Fax:
Practice Address - Street 1:823 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-3607
Practice Address - Country:US
Practice Address - Phone:530-307-9789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-08
Last Update Date:2018-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist