Provider Demographics
NPI:1518201755
Name:DAVIDSON PRAWEL, ALEESHA
Entity type:Individual
Prefix:
First Name:ALEESHA
Middle Name:
Last Name:DAVIDSON PRAWEL
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 1:4420 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-1929
Mailing Address - Country:US
Mailing Address - Phone:970-667-8160
Mailing Address - Fax:
Practice Address - Street 1:4420 MONROE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-1929
Practice Address - Country:US
Practice Address - Phone:970-667-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-10
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000021253133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist