Healthcare Provider Details

I. General information

NPI: 1902147614
Provider Name (Legal Business Name): BRITNI LORENA SULLIVAN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE STE 300 DEPAUL BUILDING
WASHINGTON DC
20017-2103
US

IV. Provider business mailing address

1160 VARNUM ST NE STE 300 DEPAUL BUILDING
WASHINGTON DC
20017-2103
US

V. Phone/Fax

Practice location:
  • Phone: 202-534-4241
  • Fax: 202-448-4080
Mailing address:
  • Phone: 202-534-4241
  • Fax: 202-448-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI100000416
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: