Provider Demographics
NPI:1437866076
Name:BROWN, MARYROSE ESTELLE (RD)
Entity Type:Individual
Prefix:
First Name:MARYROSE
Middle Name:ESTELLE
Last Name:BROWN
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 1:11550 MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-2442
Mailing Address - Country:US
Mailing Address - Phone:661-733-8259
Mailing Address - Fax:
Practice Address - Street 1:11550 MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-2442
Practice Address - Country:US
Practice Address - Phone:661-733-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86172075133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered