Individual provider · NPI-1

Moranda Lynn Boles, RD

Dietitian, Registered · Broomfield, CO

NPI number1245754910
StatusActive
Last updated in NPPESJul 21, 2022

Details

NPI
1245754910
Entity type
Individual (NPI-1)
Name
Moranda Lynn Boles
Credential
RD
Sex
Female
Sole proprietor
Yes
Enumeration date
Aug 3, 2017
Last updated
Jul 21, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
133V00000X Dietitian, Registered1099702COYes

Practice location

11820 Destination Dr
Broomfield, CO 80021-2518

Phone 303-460-6065

Mailing address

11820 Destination Dr
Broomfield, CO 80021-2518

Phone 303-460-6065

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