Organization
MIND BODY SOUL REVIVAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMMA O'CONNOR MS, RD, CEDS (REGISTERED DIETITIAN)
(774) 270-7018
Entity
Organization
Contact information
Practice address
845 VANCE ST, LAKEWOOD, CO 80214-4828
(774) 270-7018
Mailing address
845 VANCE ST, LAKEWOOD, CO 80214-4828
(774) 270-7018
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
—
—
Other
Enumeration date
02/11/2025
Last updated
02/11/2025
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