Provider Demographics
NPI:1447001896
Name:BOBER, JANELLE MARIE (RDN)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:MARIE
Last Name:BOBER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 BOARDWALK DR APT M204
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-6290
Mailing Address - Country:US
Mailing Address - Phone:303-945-9161
Mailing Address - Fax:
Practice Address - Street 1:3250 W 66TH ST APT 548
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5514
Practice Address - Country:US
Practice Address - Phone:651-447-6737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86326127133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered