1568973816 NPI number — HOLLY SULLIVAN REGISTERED DIETITIAN

Table of content: HOLLY SULLIVAN REGISTERED DIETITIAN (NPI 1568973816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568973816 NPI number — HOLLY SULLIVAN REGISTERED DIETITIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SULLIVAN
Provider First Name:
HOLLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED DIETITIAN
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:
1568973816
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3055 ROSLYN ST.
Provider Second Line Business Mailing Address:
SUITE 250 AF WILLIAMS BUILDING MAIL STOP B155
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-553-2750
Provider Business Mailing Address Fax Number:
720-553-2763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3055 ROSLYN ST UNIT 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80238-2778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-553-2750
Provider Business Practice Location Address Fax Number:
720-553-2763
Provider Enumeration Date:
10/13/2017

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 , with the licence number:  1035975 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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