Healthcare Provider Details

I. General information

NPI: 1033548086
Provider Name (Legal Business Name): KATEY GREENE NTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2013
Last Update Date: 11/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28677 BUFFALO PARK RD STE 204
EVERGREEN CO
80439-7378
US

IV. Provider business mailing address

635 HUMPHREY DR
EVERGREEN CO
80439-9637
US

V. Phone/Fax

Practice location:
  • Phone: 303-489-3027
  • Fax:
Mailing address:
  • Phone: 303-489-3027
  • Fax: 303-526-4072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: