MEDICARE: CASEY MARIE BRAMBLE MS, RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	86049785	CO

General Provider Information

NPI Number	:	1093548653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY MARIE BRAMBLE MS, RD

Provider Business Mailing Address
First Line	:	6010 FOSSIL DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-7682
Country	:	US
Telephone Number	:	609-713-2115
Fax Number	:

Provider Business Practice Location Address
First Line	:	6010 FOSSIL DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-7682
Country	:	US
Telephone Number	:	609-713-2115
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/21/2024

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