Healthcare Provider Details

I. General information

NPI: 1578287207
Provider Name (Legal Business Name): KATIE ANN ENWRIGHT RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4747 ARAPAHOE AVE
BOULDER CO
80303
US

IV. Provider business mailing address

4747 ARAPAHOE AVE
BOULDER CO
80303
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-7047
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86117063-CDR
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: