Healthcare Provider Details

I. General information

NPI: 1730129511
Provider Name (Legal Business Name): MARY ANN ELIZABETH SAUSSOTTE MS, RD, CNSD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MARY ANN ELIZABETH EVANS MS, RD, CNSD

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EXEMPLA CIR EXEMPLA GOOD SAMARITAN: HHC
LAFAYETTE CO
80026-3370
US

IV. Provider business mailing address

265 S BUCHANAN CIR
LOUISVILLE CO
80027-9526
US

V. Phone/Fax

Practice location:
  • Phone: 303-689-6580
  • Fax:
Mailing address:
  • Phone: 303-216-1098
  • Fax: 303-665-9601

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: