Provider Demographics
NPI:1497922355
Name:LEDDER, DRU JEAN (MS)
Entity Type:Individual
Prefix:MISS
First Name:DRU
Middle Name:JEAN
Last Name:LEDDER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 LUCINDA CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6235
Mailing Address - Country:US
Mailing Address - Phone:970-204-9084
Mailing Address - Fax:
Practice Address - Street 1:3027 LUCINDA CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-6235
Practice Address - Country:US
Practice Address - Phone:970-204-9084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
717581133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered