MEDICARE: LEAH ROHLF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1104197953	OTHER	CO	INSIDE HEALTH

General Provider Information

NPI Number	:	1164172938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH ROHLF

Provider Business Mailing Address
First Line	:	2700 MADISON SQUARE DR
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-3385
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 MADISON SQUARE DR
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-3385
Country	:	US
Telephone Number	:	970-682-8060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	03/25/2022

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