Provider Demographics
NPI:1003687864
Name:ARCHULETA, MICHELLE (RDN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ARCHULETA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7240 BRENTFORD DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3091
Mailing Address - Country:US
Mailing Address - Phone:719-351-9671
Mailing Address - Fax:
Practice Address - Street 1:7240 BRENTFORD DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3091
Practice Address - Country:US
Practice Address - Phone:719-351-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered