Provider Demographics
NPI:1366770059
Name:IVERSON, ERICA ANNE (RD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:ANNE
Last Name:IVERSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 DOWNING ST
Mailing Address - Street 2:APT 3
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1541
Mailing Address - Country:US
Mailing Address - Phone:612-203-1541
Mailing Address - Fax:
Practice Address - Street 1:13529 E 17TH PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7248
Practice Address - Country:US
Practice Address - Phone:303-365-4940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered