Provider Demographics
NPI:1548807605
Name:CASTLEBURY, MAGAN (RD)
Entity type:Individual
Prefix:
First Name:MAGAN
Middle Name:
Last Name:CASTLEBURY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10855 CIRCLE POINT RD APT Q-209
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2447
Mailing Address - Country:US
Mailing Address - Phone:316-619-9544
Mailing Address - Fax:
Practice Address - Street 1:10855 CIRCLE POINT RD APT Q-209
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-2447
Practice Address - Country:US
Practice Address - Phone:316-619-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty