Provider Demographics
NPI:1851925820
Name:NEUBAUM, BRENDA (RD, RDN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:NEUBAUM
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7343 E 8TH PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6926
Mailing Address - Country:US
Mailing Address - Phone:303-588-0893
Mailing Address - Fax:
Practice Address - Street 1:7343 E 8TH PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6926
Practice Address - Country:US
Practice Address - Phone:303-588-0893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO720096133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO25760631-0000OtherSTATE OF COLORADO