Provider Demographics
NPI:1275298002
Name:SWEENEY, KATRINA MARIE
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11555 W 106TH WAY
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-6673
Mailing Address - Country:US
Mailing Address - Phone:215-859-0024
Mailing Address - Fax:
Practice Address - Street 1:2260 BASELINE RD STE 102
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-7740
Practice Address - Country:US
Practice Address - Phone:720-899-0195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty