Provider Demographics
NPI:1154913184
Name:VAN ZIJL, MYLENE (MS, RDN, CLC)
Entity type:Individual
Prefix:
First Name:MYLENE
Middle Name:
Last Name:VAN ZIJL
Suffix:
Gender:F
Credentials:MS, RDN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 MARIPOSA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-3508
Mailing Address - Country:US
Mailing Address - Phone:303-877-6703
Mailing Address - Fax:
Practice Address - Street 1:1268 MARIPOSA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3508
Practice Address - Country:US
Practice Address - Phone:303-877-6703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86025223133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered