Provider Demographics
NPI:1922835784
Name:JANE REAGAN NUTRITION
Entity type:Organization
Organization Name:JANE REAGAN NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:REAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, RDN, CEDS-C
Authorized Official - Phone:303-953-4111
Mailing Address - Street 1:1949 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-4496
Mailing Address - Country:US
Mailing Address - Phone:303-953-4111
Mailing Address - Fax:303-330-0396
Practice Address - Street 1:1949 PEARL ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-4496
Practice Address - Country:US
Practice Address - Phone:303-953-4111
Practice Address - Fax:303-330-0396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty