Healthcare Provider Details

I. General information

NPI: 1851816250
Provider Name (Legal Business Name): HALI HARRISON MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2017
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 20TH ST STE 350
CHEYENNE WY
82001-3884
US

IV. Provider business mailing address

2602 THOREAU DR
FORT COLLINS CO
80524-1487
US

V. Phone/Fax

Practice location:
  • Phone: 307-633-7292
  • Fax: 307-633-7998
Mailing address:
  • Phone: 479-629-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number218
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: