Healthcare Provider Details

I. General information

NPI: 1457782724
Provider Name (Legal Business Name): NICOLE CAWRSE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE COOPERRIDER RD

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CLERMONT ST
DENVER CO
80220-3808
US

IV. Provider business mailing address

8606 SILVER GLEN DR
FOUNTAIN CO
80817-4067
US

V. Phone/Fax

Practice location:
  • Phone: 303-399-8020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2318
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1088318
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: