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General NPI Number Information
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NPI Number | 1235091901
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Entity Type | Organization
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Legal Business Name | THE DIETITIAN LAB
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 12270 W 57TH AVE
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City | ARVADA
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State | CO
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Zip | 80002-1371
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Country | US
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Telephone | 331-457-3031
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Fax |
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Provider Business Mailing Address
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Address Line | 12270 W 57TH AVE
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City | ARVADA
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State | CO
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Zip | 80002-1371
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BROOKE MARGARET HARTER
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Credential |
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Telephone | 331-457-3031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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