Healthcare Provider Details

I. General information

NPI: 1467470476
Provider Name (Legal Business Name): MARY ALICE PHILLIPS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY ALICE SCHROEDER

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SPECHT POINT RD STE 127
FT COLLINS CO
80525
US

IV. Provider business mailing address

1600 SPECHT POINT RD STE 127
FT COLLINS CO
80525
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-7878
  • Fax: 970-493-2682
Mailing address:
  • Phone: 970-493-7878
  • Fax: 970-493-2682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: