Healthcare Provider Details

I. General information

NPI: 1528688371
Provider Name (Legal Business Name): DEBORAH STEVENSON RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7307 S REVERE PKWY STE 200
CENTENNIAL CO
80112-3931
US

IV. Provider business mailing address

1081 CLOPTON BRIDGE DR
ROCHESTER HILLS MI
48306-3912
US

V. Phone/Fax

Practice location:
  • Phone: 303-355-4745
  • Fax:
Mailing address:
  • Phone: 720-376-3137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: