Healthcare Provider Details

I. General information

NPI: 1437866076
Provider Name (Legal Business Name): MARYROSE BROWN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRBTHERD LLC RD

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N GRANT ST STE R
DENVER CO
80203-1747
US

IV. Provider business mailing address

1500 N GRANT ST STE R
DENVER CO
80203-1747
US

V. Phone/Fax

Practice location:
  • Phone: 720-772-1049
  • Fax:
Mailing address:
  • Phone: 720-772-1049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86172075
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: