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NPI Code Detail

MEDICARE: CAMDEN THAYER TAUNTON RD

MEDICARE: CAMDEN THAYER TAUNTON RD
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
1133V00000XRegistered Dietitian86151916CO

General Provider Information

NPI Number : 1396368247
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAMDEN THAYER TAUNTON RD
Provider Business Mailing Address
First Line : 25 N EMERSON ST APT 202
Second Line :
City : DENVER
State : CO
Zip : 80218-3734
Country : US
Telephone Number : 720-224-8851
Fax Number :
Provider Business Practice Location Address
First Line : 4450 E JEWELL AVE
Second Line :
City : DENVER
State : CO
Zip : 80222-4605
Country : US
Telephone Number : 303-757-7467
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2020
Last Update Date : 05/26/2023

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Directions to “ CAMDEN THAYER TAUNTON RD” Practice Location

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