Provider Demographics
NPI:1144856444
Name:BUTLER, BROOKE (RD, CEDRD-S)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BUTLER
Suffix:
Gender:F
Credentials:RD, CEDRD-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 N FRANKLIN ST STE 500
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1169
Mailing Address - Country:US
Mailing Address - Phone:303-731-8921
Mailing Address - Fax:
Practice Address - Street 1:1830 N FRANKLIN ST STE 500
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1169
Practice Address - Country:US
Practice Address - Phone:303-731-8921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1017056133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered