Provider Demographics
NPI:1144056342
Name:SEDERBERG, CHARIS MARIE (RN, CNTP)
Entity type:Individual
Prefix:
First Name:CHARIS
Middle Name:MARIE
Last Name:SEDERBERG
Suffix:
Gender:F
Credentials:RN, CNTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16396 W 54TH DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-1277
Mailing Address - Country:US
Mailing Address - Phone:303-503-2437
Mailing Address - Fax:
Practice Address - Street 1:16396 W 54TH DR
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80403-1277
Practice Address - Country:US
Practice Address - Phone:303-503-2437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education