Provider Demographics
NPI:1831952217
Name:BENGTSON, TENIA BRIANNE (CPHT, NUTRITIONIST)
Entity type:Individual
Prefix:
First Name:TENIA
Middle Name:BRIANNE
Last Name:BENGTSON
Suffix:
Gender:F
Credentials:CPHT, NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12108 MELODY DR APT 204
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2116
Mailing Address - Country:US
Mailing Address - Phone:720-403-6553
Mailing Address - Fax:720-707-1640
Practice Address - Street 1:1499 W 120TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2719
Practice Address - Country:US
Practice Address - Phone:720-403-6553
Practice Address - Fax:720-710-1308
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHAT.0010237133NN1002X, 183700000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No183700000XPharmacy Service ProvidersPharmacy Technician