=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295099315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HALF YOUR SIZE., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2012
-----------------------------------------------------
Last Update Date | 07/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8081 E ORCHARD RD 2ND FLOOR, SUITE 215
-----------------------------------------------------
City | GREENWOOD VILLAGE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-792-9899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8081 E ORCHARD RD 2ND FLOOR, SUITE 215
-----------------------------------------------------
City | GREENWOOD VILLAGE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-2501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-792-9899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PATIENT BILLING
-----------------------------------------------------
Name | MS. JENNIFER NATALE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-792-9899
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133NN1002X
-----------------------------------------------------
Taxonomy Name | Nutrition Education Nutritionist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------