1548357015 NPI number — CASSANDRA RENEE BRITTON RD REGISTERED DIET

Table of content: CASSANDRA RENEE BRITTON RD REGISTERED DIET (NPI 1548357015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548357015 NPI number — CASSANDRA RENEE BRITTON RD REGISTERED DIET

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRITTON
Provider First Name:
CASSANDRA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RD REGISTERED DIET
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548357015
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2864 ASHMUN STREET
Provider Second Line Business Mailing Address:
SAULT TRIBAL HEALTH CTR
Provider Business Mailing Address City Name:
SAULT SAINTE MARIE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-632-5200
Provider Business Mailing Address Fax Number:
906-632-5276

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
M 28 EAST
Provider Second Line Business Practice Location Address:
MUNISING TRIBAL HEALTH CENTER
Provider Business Practice Location Address City Name:
WETMORE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-387-4721
Provider Business Practice Location Address Fax Number:
906-387-4727
Provider Enumeration Date:
10/06/2006

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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