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General NPI Number Information
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NPI Number | 1427426477
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Entity Type | Organization
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Legal Business Name | BRAVE NUTRITION LLC
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Dates
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Enumeration Date | 09/08/2015
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Last Update Date | 09/08/2015
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Provider Practice Location Address
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Address Line | 534 WESTLAKE AVE N SUITE 240
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City | SEATTLE
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State | WA
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Zip | 98109-4305
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Country | US
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Telephone | 206-578-5843
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 97115
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City | LAKEWOOD
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State | WA
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Zip | 98497-0115
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Country | US
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Telephone | 253-588-7911
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Fax | 253-369-6299
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | PROF. BROOKE D JEFFRIES
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Credential | MS, CN
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Telephone | 206-578-5843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | AHY718654003
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License Number State | WA
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