Healthcare Provider Details

I. General information

NPI: 1164675013
Provider Name (Legal Business Name): GRETCHEN A BROECKER MS, RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS GRETCHEN A BUEGE

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PEAK ONE DRIVE STE 260
FRISCO CO
80443-0000
US

IV. Provider business mailing address

360 PEAK ONE DR 390
FRISCO CO
80443
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-5584
  • Fax: 970-262-2196
Mailing address:
  • Phone: 970-668-5584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number885627
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: