Healthcare Provider Details

I. General information

NPI: 1184405318
Provider Name (Legal Business Name): MS. MICHAELA ROWLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4763 E ILIFF AVE
DENVER CO
80222-6024
US

IV. Provider business mailing address

4763 E ILIFF AVE
DENVER CO
80222-6024
US

V. Phone/Fax

Practice location:
  • Phone: 917-225-0665
  • Fax:
Mailing address:
  • Phone: 917-225-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number86019309
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: