Provider Demographics
NPI:1427459288
Name:STREET, DANIELLE RENIE (RD)
Entity type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:RENIE
Last Name:STREET
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MRS
Other - First Name:DANIELLE
Other - Middle Name:RENIE
Other - Last Name:COTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:5771 CALGARY ST
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-2272
Mailing Address - Country:US
Mailing Address - Phone:719-659-9114
Mailing Address - Fax:
Practice Address - Street 1:5771 CALGARY ST
Practice Address - Street 2:
Practice Address - City:TIMNATH
Practice Address - State:CO
Practice Address - Zip Code:80547-2272
Practice Address - Country:US
Practice Address - Phone:719-659-9114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO813277133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered