Healthcare Provider Details

I. General information

NPI: 1447351911
Provider Name (Legal Business Name): AMBER BRUST RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE M/S W3726
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

PO BOX 5371
SEATTLE WA
98105-0371
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-5435
  • Fax: 206-987-5087
Mailing address:
  • Phone: 206-987-5435
  • Fax: 206-987-5087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDI00001444
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: