Provider Demographics
NPI:1891290607
Name:HUITING, MIRANDA (RD)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:HUITING
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4278 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7928
Mailing Address - Country:US
Mailing Address - Phone:209-826-5337
Mailing Address - Fax:
Practice Address - Street 1:4278 CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7928
Practice Address - Country:US
Practice Address - Phone:209-826-5337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86079803133V00000X
CO86079803133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered