Healthcare Provider Details

I. General information

NPI: 1053827956
Provider Name (Legal Business Name): PAIGE BRIGGS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WALLACE WAY
GRANDVIEW WA
98930-8805
US

IV. Provider business mailing address

1529 COLUMBIA PARK TRL APT C223
RICHLAND WA
99352-8699
US

V. Phone/Fax

Practice location:
  • Phone: 509-882-3444
  • Fax:
Mailing address:
  • Phone: 217-714-0298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86061993
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: