1366872848 NPI number — MOIRA CHRISTINE GERD MED, RD

Table of content: MOIRA CHRISTINE GERD MED, RD (NPI 1366872848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366872848 NPI number — MOIRA CHRISTINE GERD MED, RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERD
Provider First Name:
MOIRA
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MED, RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366872848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1835 FRANKLIN ST
Provider Second Line Business Mailing Address:
ST. JOSEPH HOSPITAL: CLINICAL DIETITIANS DEPARTMENT
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80218-1126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-837-7039
Provider Business Mailing Address Fax Number:
303-837-6725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1960 NORTH OGDEN ST
Provider Second Line Business Practice Location Address:
SR. JOANNA BRUNER FAMILY MED CLINIC, STE 460
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-318-2581
Provider Business Practice Location Address Fax Number:
303-318-2536
Provider Enumeration Date:
11/19/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)