Provider Demographics
NPI:1568973816
Name:SULLIVAN, HOLLY (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:SULLIVAN
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 ROSLYN ST.
Mailing Address - Street 2:SUITE 250 AF WILLIAMS BUILDING MAIL STOP B155
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238
Mailing Address - Country:US
Mailing Address - Phone:720-553-2750
Mailing Address - Fax:720-553-2763
Practice Address - Street 1:3055 ROSLYN ST UNIT 250
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2778
Practice Address - Country:US
Practice Address - Phone:720-553-2750
Practice Address - Fax:720-553-2763
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1035975133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered