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General NPI Number Information
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NPI Number | 1710961206
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Entity Type | Individual
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Provider Name | SUZANNE Y PECORARO
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Gender | Female
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 1155 ALPINE AVE STE 260
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City | BOULDER
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State | CO
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Zip | 80304-3495
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Country | US
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Telephone | 303-444-4441
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Fax | 303-444-2015
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Provider Business Mailing Address
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Address Line | 345 MAXWELL AVE
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City | BOULDER
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State | CO
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Zip | 80304-3972
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Country | US
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Telephone | 303-544-5777
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Fax | 303-544-5775
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | R344988
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License Number State | CO
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