Provider Demographics
NPI:1265995591
Name:ODONOVAN, MARY JULE ODEA (RD, LDN)
Entity type:Individual
Prefix:
First Name:MARY JULE
Middle Name:ODEA
Last Name:ODONOVAN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JULE
Other - Last Name:ODEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:980 N MARION ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-3015
Mailing Address - Country:US
Mailing Address - Phone:303-919-1281
Mailing Address - Fax:
Practice Address - Street 1:980 N MARION ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3015
Practice Address - Country:US
Practice Address - Phone:303-919-1281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4693133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered