Provider Demographics
NPI:1609575257
Name:HARTNETT, PAIGE
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:HARTNETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3387 W MONCRIEFF PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3163
Mailing Address - Country:US
Mailing Address - Phone:813-391-6126
Mailing Address - Fax:
Practice Address - Street 1:3387 W MONCRIEFF PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3163
Practice Address - Country:US
Practice Address - Phone:813-391-6126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86098428133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered