Healthcare Provider Details

I. General information

NPI: 1083534150
Provider Name (Legal Business Name): BRIANNA POOLE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 STRATHMORE LN APT 110
LAFAYETTE CO
80026-2175
US

IV. Provider business mailing address

455 STRATHMORE LN APT 110
LAFAYETTE CO
80026-2175
US

V. Phone/Fax

Practice location:
  • Phone: 505-501-9015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: