Healthcare Provider Details

I. General information

NPI: 1336549955
Provider Name (Legal Business Name): MAUREEN WEST CNTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 COOK ST #108
DENVER CO
80206-5331
US

IV. Provider business mailing address

180 COOK ST #108
DENVER CO
80206-5331
US

V. Phone/Fax

Practice location:
  • Phone: 407-921-9192
  • Fax:
Mailing address:
  • Phone: 407-921-9192
  • 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: