MEDICARE: MADELINE VANCUREN RDN

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	:	1598505307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE VANCUREN RDN

Provider Business Mailing Address
First Line	:	219 W MULBERRY ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2813
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 W MULBERRY ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-2813
Country	:	US
Telephone Number	:	907-654-7010
Fax Number	:

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

Provider Enumeration Date	:	05/29/2024
Last Update Date	:	05/29/2024

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Directions to “ MADELINE VANCUREN RDN” Practice Location

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