Provider Demographics
NPI:1255954970
Name:HERRITT, CAMERON TODD (RD)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:TODD
Last Name:HERRITT
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E DRAKE RD APT Q3
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4623
Mailing Address - Country:US
Mailing Address - Phone:704-756-2404
Mailing Address - Fax:
Practice Address - Street 1:700 E DRAKE RD APT Q3
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4623
Practice Address - Country:US
Practice Address - Phone:704-756-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86018558133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered