Provider Demographics
NPI:1922981174
Name:GARDNER, JULIE MARIE (MS, RD, CNSC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MARIE
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MS, RD, CNSC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:MARIE
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JULIE RAYMOND
Mailing Address - Street 1:111 CANYON VISTA LN
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-3005
Mailing Address - Country:US
Mailing Address - Phone:303-929-8252
Mailing Address - Fax:
Practice Address - Street 1:111 CANYON VISTA LN
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465-3005
Practice Address - Country:US
Practice Address - Phone:303-929-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86046473133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered