Healthcare Provider Details

I. General information

NPI: 1891285680
Provider Name (Legal Business Name): MARANDA STONE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 MOUNTAIN VIEW AVE
LONGMONT CO
80501-3128
US

IV. Provider business mailing address

700 KEN PRATT BLVD STE 206-131
LONGMONT CO
80501-6452
US

V. Phone/Fax

Practice location:
  • Phone: 720-494-3119
  • Fax: 720-494-3171
Mailing address:
  • Phone: 720-494-3119
  • Fax: 720-494-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86001295
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code133VN1201X
TaxonomyObesity and Weight Management Nutrition Registered Dietitian
License Number86001295
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: