Provider Demographics
NPI:1407627003
Name:MISKOVSKY, LAUREN (RD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MISKOVSKY
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 1:3485 TELLER ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6272
Mailing Address - Country:US
Mailing Address - Phone:802-345-4827
Mailing Address - Fax:
Practice Address - Street 1:3485 TELLER ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80033-6272
Practice Address - Country:US
Practice Address - Phone:802-345-4827
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 Licenses
StateLicense IDTaxonomies
CO86417484133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered