1528431319 NPI number — BRITTANY LAINE O'BRYAN DIETITIAN

Table of content: BRITTANY LAINE O'BRYAN DIETITIAN (NPI 1528431319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528431319 NPI number — BRITTANY LAINE O'BRYAN DIETITIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'BRYAN
Provider First Name:
BRITTANY
Provider Middle Name:
LAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DIETITIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SONNIER
Provider Other First Name:
BRITTANY
Provider Other Middle Name:
LAINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DIETITIAN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528431319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15790 PAUL VEGA MD DR
Provider Second Line Business Mailing Address:
NUTRITIONAL SERVICES
Provider Business Mailing Address City Name:
HAMMOND
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70403-1434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-230-6772
Provider Business Mailing Address Fax Number:
985-230-6563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15790 PAUL VEGA MD DR
Provider Second Line Business Practice Location Address:
NUTRITIONAL SERVICES
Provider Business Practice Location Address City Name:
HAMMOND
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70403-1434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-230-6772
Provider Business Practice Location Address Fax Number:
985-230-6563
Provider Enumeration Date:
11/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  2293 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2293 . This is a "DIETITIAN CERTIFICATION NUMBER" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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