Healthcare Provider Details

I. General information

NPI: 1720742315
Provider Name (Legal Business Name): BRANDY CUMMINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 NE 63RD ST STE 250
VANCOUVER WA
98661-1980
US

IV. Provider business mailing address

6715 NE 63RD ST STE 250
VANCOUVER WA
98661-1980
US

V. Phone/Fax

Practice location:
  • Phone: 360-818-4815
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU60955823
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: