Provider Demographics
NPI:1730691569
Name:BROWN, MARY KATHERINE (RD/RDN/LD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RD/RDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 S LEMAY AVE STE 7-253
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2247
Mailing Address - Country:US
Mailing Address - Phone:405-474-4833
Mailing Address - Fax:
Practice Address - Street 1:300 E HORSETOOTH RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3154
Practice Address - Country:US
Practice Address - Phone:405-474-4833
Practice Address - Fax:833-333-1502
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1063613133V00000X
CO1063613133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered