Provider Demographics
NPI:1679128938
Name:SWENSON, EMMA ELAINE (RD)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:ELAINE
Last Name:SWENSON
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 1:256 MCCASLIN BLVD APT 205
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-2921
Mailing Address - Country:US
Mailing Address - Phone:435-770-5887
Mailing Address - Fax:
Practice Address - Street 1:2935 BASELINE RD STE 302
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2367
Practice Address - Country:US
Practice Address - Phone:720-315-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86110547133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86110547OtherRDN NUMBER