Provider Demographics
NPI:1578071874
Name:MILLARD, JENNIFER (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MILLARD
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 1:8378 BRIAR TRACE WAY
Mailing Address - Street 2:
Mailing Address - City:CASTLE PINES
Mailing Address - State:CO
Mailing Address - Zip Code:80108-5513
Mailing Address - Country:US
Mailing Address - Phone:720-346-3070
Mailing Address - Fax:
Practice Address - Street 1:8378 BRIAR TRACE WAY
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-5513
Practice Address - Country:US
Practice Address - Phone:720-346-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-21
Last Update Date:2018-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86044806133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered