Provider Demographics
NPI:1659993160
Name:ENGLE, ANDREA L (MS NUTRITION, LMT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:ENGLE
Suffix:
Gender:F
Credentials:MS NUTRITION, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 11TH AVE UNIT 4A
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-3663
Mailing Address - Country:US
Mailing Address - Phone:720-626-8988
Mailing Address - Fax:
Practice Address - Street 1:300 W 11TH AVE UNIT 4A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3663
Practice Address - Country:US
Practice Address - Phone:720-626-8988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT0009182225700000X
133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist