Healthcare Provider Details

I. General information

NPI: 1740851849
Provider Name (Legal Business Name): BROWNE BAG NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3324 VALLEY LEE S
LAUREL MD
20724-2449
US

IV. Provider business mailing address

3324 VALLEY LEE S
LAUREL MD
20724-2449
US

V. Phone/Fax

Practice location:
  • Phone: 860-301-9482
  • Fax:
Mailing address:
  • Phone: 860-301-9482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN BISHEL BROWNE
Title or Position: PROPRIETOR
Credential: CNS, LDN
Phone: 860-301-9482