Healthcare Provider Details

I. General information

NPI: 1881359602
Provider Name (Legal Business Name): ERIN LIVERS ICNT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 S 42ND ST
BOULDER CO
80305-5453
US

IV. Provider business mailing address

PO BOX 3766
BOULDER CO
80307-3766
US

V. Phone/Fax

Practice location:
  • Phone: 720-730-9090
  • Fax:
Mailing address:
  • Phone: 720-730-9090
  • Fax:

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: