Healthcare Provider Details

I. General information

NPI: 1558334755
Provider Name (Legal Business Name): LORRAINE RUPP BREEN MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED ARMY MEDICAL CENTER 6900 GEORGIA AVENUE, NW
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

6630 CHARLES GREEN SQ
ALEXANDRIA VA
22315-6036
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-2020
  • Fax:
Mailing address:
  • Phone: 703-298-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number497689
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: