Provider Demographics
NPI:1699248310
Name:GRUENHAUPT, MIRANDA (RD)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:GRUENHAUPT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 W HOOVER AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-6885
Mailing Address - Country:US
Mailing Address - Phone:303-918-3273
Mailing Address - Fax:
Practice Address - Street 1:6003 W HOOVER AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-6885
Practice Address - Country:US
Practice Address - Phone:303-918-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered