Healthcare Provider Details

I. General information

NPI: 1669105276
Provider Name (Legal Business Name): TREVA MILLARD RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2748 CROSSROADS BLVD
GRAND JUNCTION CO
81506-3933
US

IV. Provider business mailing address

2748 CROSSROADS BLVD
GRAND JUNCTION CO
81506-3933
US

V. Phone/Fax

Practice location:
  • Phone: 970-255-0919
  • Fax: 970-255-0901
Mailing address:
  • Phone: 970-255-0919
  • Fax: 970-255-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number985773
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: