Provider Demographics
NPI:1417408451
Name:MOORE, LAUREN (MS, RD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 COOK ST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:165 COOK ST
Practice Address - Street 2:SUITE 10
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5323
Practice Address - Country:US
Practice Address - Phone:303-505-1439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1094117133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered