Healthcare Provider Details

I. General information

NPI: 1417840018
Provider Name (Legal Business Name): GINA RAE OBRIAN RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 W HAYWARD PL
DENVER CO
80211-3719
US

IV. Provider business mailing address

3225 W HAYWARD PL
DENVER CO
80211-3719
US

V. Phone/Fax

Practice location:
  • Phone: 720-320-6631
  • Fax:
Mailing address:
  • Phone: 720-320-6631
  • 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: