Healthcare Provider Details

I. General information

NPI: 1114278215
Provider Name (Legal Business Name): MARLEY BRAUN R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLEY PEALE R.D.

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N 145TH ST
SEATTLE WA
98133-6522
US

IV. Provider business mailing address

1946 NW 97TH ST
SEATTLE WA
98117-2435
US

V. Phone/Fax

Practice location:
  • Phone: 206-604-4707
  • Fax:
Mailing address:
  • Phone: 434-249-2445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI 60310837
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: