MEDICARE: BRITNI LORENA SULLIVAN RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DI100000416	DC

General Provider Information

NPI Number	:	1902147614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITNI LORENA SULLIVAN RD

Provider Business Mailing Address
First Line	:	1160 VARNUM ST NE STE 300
Second Line	:	DEPAUL BUILDING
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2103
Country	:	US
Telephone Number	:	202-534-4241
Fax Number	:	202-448-4080

Provider Business Practice Location Address
First Line	:	1160 VARNUM ST NE STE 300
Second Line	:	DEPAUL BUILDING
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2103
Country	:	US
Telephone Number	:	202-534-4241
Fax Number	:	202-448-4080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	03/06/2013

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