Provider Demographics
NPI:1750736799
Name:ECKERT, KARIN (CNTP)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:ECKERT
Suffix:
Gender:F
Credentials:CNTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 HOMESTEAD ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9416
Mailing Address - Country:US
Mailing Address - Phone:719-838-0029
Mailing Address - Fax:
Practice Address - Street 1:526 HOMESTEAD ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-9416
Practice Address - Country:US
Practice Address - Phone:719-838-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist