Healthcare Provider Details

I. General information

NPI: 1346725298
Provider Name (Legal Business Name): COLLEEN WYSOCKI MS, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN WOODS MS, RDN

II. Dates (important events)

Enumeration Date: 09/26/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 S COLORADO BLVD STE 100
DENVER CO
80246-8019
US

IV. Provider business mailing address

1637 WESTBRIDGE DR UNIT I1
FORT COLLINS CO
80526-7202
US

V. Phone/Fax

Practice location:
  • Phone: 970-889-5303
  • Fax:
Mailing address:
  • Phone: 970-889-5303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: