Healthcare Provider Details

I. General information

NPI: 1114549516
Provider Name (Legal Business Name): DOROTHY MEGAN BERENS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EXEMPLA CIR
LAFAYETTE CO
80026-3370
US

IV. Provider business mailing address

11547 W 102ND PL
WESTMINSTER CO
80021-6615
US

V. Phone/Fax

Practice location:
  • Phone: 303-689-4000
  • Fax:
Mailing address:
  • Phone: 303-775-2485
  • 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: