Provider Demographics
NPI:1437461829
Name:HENZE, MARTHA (MS, RD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:HENZE
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 1:995 GILLASPIE DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6543
Mailing Address - Country:US
Mailing Address - Phone:303-499-1002
Mailing Address - Fax:
Practice Address - Street 1:13150 W 72ND AVE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-3116
Practice Address - Country:US
Practice Address - Phone:303-424-2739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered