Provider Demographics
NPI:1417217282
Name:MCCREA, BERNADETTE MARIE (RD)
Entity Type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:MARIE
Last Name:MCCREA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:M
Other - Last Name:MCCREA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:682 YUKON CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-3187
Mailing Address - Country:US
Mailing Address - Phone:970-227-3386
Mailing Address - Fax:970-460-0526
Practice Address - Street 1:682 YUKON CT
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-3187
Practice Address - Country:US
Practice Address - Phone:970-227-3386
Practice Address - Fax:970-227-3386
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered