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General NPI Number Information
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NPI Number | 1801423132
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Entity Type | Individual
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Provider Name | JORDAN HILL RD, CSSD
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Gender | Female
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Dates
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Enumeration Date | 03/25/2020
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 785 S LAFAYETTE DR APT 265
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City | LAFAYETTE
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State | CO
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Zip | 80026-3575
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Country | US
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Telephone | 404-547-9576
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Fax |
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Provider Business Mailing Address
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Address Line | 785 S LAFAYETTE DR APT 265
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City | LAFAYETTE
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State | CO
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Zip | 80026-3575
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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 |
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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 | 133VN1501X
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Taxonomy Name | Sports Dietetics Nutrition Registered Dietitian
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License Number | 86056727
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86056727
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License Number State | OR
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