Provider Demographics
NPI:1508371832
Name:DEBOER, DANA
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:DEBOER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 S SYRACUSE WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3832
Mailing Address - Country:US
Mailing Address - Phone:262-945-0966
Mailing Address - Fax:
Practice Address - Street 1:2575 SOUTH SYRACUSE WAY
Practice Address - Street 2:J104
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-8023
Practice Address - Country:US
Practice Address - Phone:262-945-0966
Practice Address - Fax:262-945-0966
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist