MEDICARE: LAURA JEAN TONSITS

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1417038563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA JEAN TONSITS

Provider Business Mailing Address
First Line	:	DEPT 1193
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80291-1193
Country	:	US
Telephone Number	:	303-486-5504
Fax Number	:	303-486-5501

Provider Business Practice Location Address
First Line	:	3207 N ACADEMY BLVD
Second Line	:	NO. 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5100
Country	:	US
Telephone Number	:	719-776-3600
Fax Number	:	719-776-3610

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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