Provider Demographics
NPI:1043305584
Name:PUDWILL, NANCY (RD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:PUDWILL
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 1:950 S. CHERRY ST
Mailing Address - Street 2:#412
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246
Mailing Address - Country:US
Mailing Address - Phone:303-550-6390
Mailing Address - Fax:303-758-3872
Practice Address - Street 1:950 S. CHERRY ST
Practice Address - Street 2:#412
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246
Practice Address - Country:US
Practice Address - Phone:303-550-6390
Practice Address - Fax:303-758-3872
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
377167133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered