Provider Demographics
NPI:1942814348
Name:WAMPLER, MAESON (RDN, CNSC)
Entity Type:Individual
Prefix:MS
First Name:MAESON
Middle Name:
Last Name:WAMPLER
Suffix:
Gender:F
Credentials:RDN, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 E IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2746
Mailing Address - Country:US
Mailing Address - Phone:615-598-5030
Mailing Address - Fax:
Practice Address - Street 1:52 MONROE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5644
Practice Address - Country:US
Practice Address - Phone:303-393-1726
Practice Address - Fax:303-200-9009
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered