MEDICARE: MS. JENNIFER HOLT RD

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	86040164	CO

General Provider Information

NPI Number	:	1164897997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER HOLT RD

Provider Business Mailing Address
First Line	:	1935 PEARL ST
Second Line	:	APT 3430
City	:	DENVER
State	:	CO
Zip	:	80203
Country	:	US
Telephone Number	:	623-695-5924
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 PEARL ST
Second Line	:	APT 3430
City	:	DENVER
State	:	CO
Zip	:	80203
Country	:	US
Telephone Number	:	623-695-5924
Fax Number	:

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

Provider Enumeration Date	:	12/04/2015
Last Update Date	:	12/04/2015

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