MEDICARE: DIGESTIVE DIETITIAN LLC

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	:	1417765165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGESTIVE DIETITIAN LLC

Provider Business Mailing Address
First Line	:	1500 N GRANT ST # 5747
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	720-450-7772
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 N GRANT ST # 5747
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1859
Country	:	US
Telephone Number	:	720-450-7772
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NICOLE LINDEL
Credential	:	RDN
Telephone Number	:	631-275-6348

Provider Enumeration Date	:	12/27/2024
Last Update Date	:	08/27/2025

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