MEDICARE: MS. VIVIAN ANN BRADFORD R.D.

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	:	1598824419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIVIAN ANN BRADFORD R.D.

Provider Business Mailing Address
First Line	:	6930 S. BEMIS ST.
Second Line	:
City	:	LITTLETON
State	:	CO
Zip	:	80120-3649
Country	:	US
Telephone Number	:	303-798-1173
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W. COUNTY LINE RD.
Second Line	:	SUITE 130
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-2342
Country	:	US
Telephone Number	:	303-791-0418
Fax Number	:	303-791-9113

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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