Basic Information
| Provider Information | |||||||||
| NPI: | 1114594710 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | DARBY | ||||||||
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| Credential: | RDN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 S OGDEN ST | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802094422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6014334555 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1501 S POTOMAC ST | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800125411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036952600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2021 | ||||||||
| LastUpdateDate: | 06/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 86292749 | CO | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.