MEDICARE: MICHELLE ARCHULETA RDN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1003687864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ARCHULETA RDN

Provider Business Mailing Address
First Line	:	7240 BRENTFORD DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3091
Country	:	US
Telephone Number	:	719-351-9671
Fax Number	:

Provider Business Practice Location Address
First Line	:	7240 BRENTFORD DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3091
Country	:	US
Telephone Number	:	719-351-9671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	01/11/2024

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