Provider Demographics
NPI:1881210110
Name:MITCHELL, LAUREN VICTORIA (MS, RD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:VICTORIA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CASTLE CREEK ROAD
Mailing Address - Street 2:NUTRITION SERVICES
Mailing Address - City:ASPEN
Mailing Address - State:CO
Mailing Address - Zip Code:81611
Mailing Address - Country:US
Mailing Address - Phone:970-544-1145
Mailing Address - Fax:
Practice Address - Street 1:401 CASTLE CREEK ROAD
Practice Address - Street 2:NUTRITION SERVICES
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611
Practice Address - Country:US
Practice Address - Phone:970-544-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86100587133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered