Provider Demographics
NPI:1790449569
Name:WIESE, GRETCHEN NICOLE (MS, RD)
Entity Type:Individual
Prefix:MISS
First Name:GRETCHEN
Middle Name:NICOLE
Last Name:WIESE
Suffix:
Gender:F
Credentials:MS, RD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7100 E MISSISSIPPI AVE APT 27-203
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80224-3167
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12100 E ILIFF AVE STE 102
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1277
Practice Address - Country:US
Practice Address - Phone:720-262-7281
Practice Address - Fax:720-372-4504
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN86080414133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered