Provider Demographics
NPI:1023760592
Name:CHEN, ALISA MERIEL
Entity type:Individual
Prefix:MS
First Name:ALISA
Middle Name:MERIEL
Last Name:CHEN
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 1:5471 W 97TH PL UNIT A
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-0968
Mailing Address - Country:US
Mailing Address - Phone:720-499-9648
Mailing Address - Fax:
Practice Address - Street 1:5471 W 97TH PL UNIT A
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-0968
Practice Address - Country:US
Practice Address - Phone:720-499-9648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist