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General NPI Number Information
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NPI Number | 1588077226
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Entity Type | Organization
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Legal Business Name | LORI S. BRIZEE PEDIATRIC NUTRITION CONSULTATION LLC
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Dates
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Enumeration Date | 06/10/2014
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 516 SW 13TH ST SUITE 101
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City | BEND
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State | OR
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Zip | 97702-3206
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Country | US
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Telephone | 541-306-6801
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Fax | 541-312-4670
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Provider Business Mailing Address
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Address Line | 61456 ELDER RIDGE ST
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City | BEND
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State | OR
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Zip | 97702-1193
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Country | US
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Telephone | 541-788-2625
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Fax | 541-312-4670
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Authorized Official
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Title or Position | REGISTERED DIETITIAN, OWNER
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Name | MS. LORI S BRIZEE
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Credential | RD, LD
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Telephone | 541-306-6801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | LDD000706
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License Number State | OR
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