Healthcare Provider Details

I. General information

NPI: 1831304120
Provider Name (Legal Business Name): AUBURN S FOWLER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 11/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 S LEMAY AVE
FORT COLLINS CO
80524-3929
US

IV. Provider business mailing address

409 TERRI DR
LOVELAND CO
80537-4100
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-8041
  • Fax:
Mailing address:
  • Phone: 843-465-0487
  • 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: