Provider Demographics
NPI:1114334901
Name:O'NEILL, ELLEN (RDN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:O'NEILL
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 1:809 E DRAKE RD APT 110
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1955
Mailing Address - Country:US
Mailing Address - Phone:970-988-5007
Mailing Address - Fax:
Practice Address - Street 1:809 E DRAKE RD APT 110
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1955
Practice Address - Country:US
Practice Address - Phone:970-988-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered