Provider Demographics
NPI:1821866062
Name:HOLLER, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:HOLLER
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 1:30 S EMERSON ST APT 304
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-2238
Mailing Address - Country:US
Mailing Address - Phone:603-583-0183
Mailing Address - Fax:
Practice Address - Street 1:30 S EMERSON ST APT 304
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-2238
Practice Address - Country:US
Practice Address - Phone:603-583-0183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist