Provider Demographics
NPI:1063655926
Name:DEZARN, DEBRA KLOHS (RD)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:KLOHS
Last Name:DEZARN
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 1:6469 MOSS CIR
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-6934
Mailing Address - Country:US
Mailing Address - Phone:303-424-1498
Mailing Address - Fax:303-424-1498
Practice Address - Street 1:6469 MOSS CIR
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80007-6934
Practice Address - Country:US
Practice Address - Phone:303-424-1498
Practice Address - Fax:303-424-1498
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
370146133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered