Healthcare Provider Details

I. General information

NPI: 1407186133
Provider Name (Legal Business Name): BRANDON KREBS B.S. R.D. LDN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 OAK ST. LONGFELLOW SPORTS CLUB
NATICK MA
01760-0000
US

IV. Provider business mailing address

203 OAK ST. LONGFELLOW SPORTS CLUB
NATICK MA
01760
US

V. Phone/Fax

Practice location:
  • Phone: 508-653-4633
  • Fax: 508-650-4986
Mailing address:
  • Phone: 508-653-4633
  • Fax: 508-650-4986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: