Healthcare Provider Details

I. General information

NPI: 1447563523
Provider Name (Legal Business Name): SHARON M POPE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S UNION BLVD MEMORIAL HEALTH SYSTEM DISEASE AND WELLNESS OFFICE
COLORADO SPRINGS CO
80910-3113
US

IV. Provider business mailing address

1400 E BOULDER ST MEMORIAL HEALTH SYSTEM NUTRITION SERVICES -SODEXO
COLORADO SPRINGS CO
80909-5533
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-5738
  • Fax: 719-365-9519
Mailing address:
  • Phone: 719-365-5738
  • Fax: 719-365-9519

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: