Provider Demographics
NPI:1992271977
Name:REICHENBERGER, LAURA REBECCA (CNTP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:REBECCA
Last Name:REICHENBERGER
Suffix:
Gender:F
Credentials:CNTP
Other - Prefix:
Other - First Name:BECCA
Other - Middle Name:
Other - Last Name:REICHENBERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNTP
Mailing Address - Street 1:777 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:777 S HIGH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-4528
Practice Address - Country:US
Practice Address - Phone:720-445-2868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist