Provider Demographics
NPI:1295092039
Name:KOSICK, SARA MAUREEN (MASTER NUTRITION THE)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MAUREEN
Last Name:KOSICK
Suffix:
Gender:F
Credentials:MASTER NUTRITION THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2955 E 1ST AVE STE. 200
Mailing Address - Street 2:PURAVIDA
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206
Mailing Address - Country:US
Mailing Address - Phone:303-999-2934
Mailing Address - Fax:
Practice Address - Street 1:2955 E 1ST AVE STE. 200
Practice Address - Street 2:PURAVIDA
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206
Practice Address - Country:US
Practice Address - Phone:303-999-2934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist