Provider Demographics
NPI:1588912372
Name:MERTZ, JANET RAE (MS, RD, CDE, CPT, LD)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:RAE
Last Name:MERTZ
Suffix:
Gender:F
Credentials:MS, RD, CDE, CPT, LD
Other - Prefix:MISS
Other - First Name:JANET
Other - Middle Name:RAE
Other - Last Name:REZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5158 FALLGOLD DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5690
Mailing Address - Country:US
Mailing Address - Phone:970-292-8432
Mailing Address - Fax:970-292-8432
Practice Address - Street 1:5158 FALLGOLD DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5690
Practice Address - Country:US
Practice Address - Phone:970-292-8432
Practice Address - Fax:970-292-8432
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR695133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered