Healthcare Provider Details

I. General information

NPI: 1285116418
Provider Name (Legal Business Name): EMILY J IPSEN CNTP, MNT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 TANAGER DR
GLENWOOD SPRINGS CO
81601-2728
US

IV. Provider business mailing address

90 TANAGER DR
GLENWOOD SPRINGS CO
81601-2728
US

V. Phone/Fax

Practice location:
  • Phone: 303-590-4360
  • Fax:
Mailing address:
  • Phone: 303-590-4360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: