MEDICARE: LANNEA RUSSELL R.D.N.

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	1034544	CO

General Provider Information

NPI Number	:	1053737379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANNEA RUSSELL R.D.N.

Provider Business Mailing Address
First Line	:	1257 VINE ST
Second Line	:	204
City	:	DENVER
State	:	CO
Zip	:	80206-2915
Country	:	US
Telephone Number	:	970-218-9621
Fax Number	:

Provider Business Practice Location Address
First Line	:	1532 GALENA ST
Second Line	:	SUITE 300
City	:	AURORA
State	:	CO
Zip	:	80010-2287
Country	:	US
Telephone Number	:	303-900-8639
Fax Number	:

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

Provider Enumeration Date	:	03/11/2014
Last Update Date	:	03/11/2014

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