Provider Demographics
NPI:1124386008
Name:ULRICH, ANDREA HARRINGTON (MS, RD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:HARRINGTON
Last Name:ULRICH
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 FARTHING DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-5969
Mailing Address - Country:US
Mailing Address - Phone:719-375-8645
Mailing Address - Fax:
Practice Address - Street 1:4820 FARTHING DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-5969
Practice Address - Country:US
Practice Address - Phone:719-375-8645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
956457133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71Medicare UPIN