Healthcare Provider Details

I. General information

NPI: 1649766056
Provider Name (Legal Business Name): MS. TIEHLOR MEREDITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12455 E MISSISSIPPI AVE UNIT 104
AURORA CO
80012-3465
US

IV. Provider business mailing address

11059 E BETHANY DR
AURORA CO
80014-2622
US

V. Phone/Fax

Practice location:
  • Phone: 303-361-8200
  • Fax:
Mailing address:
  • Phone: 303-617-2300
  • Fax: 303-617-2365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: