MEDICARE: BROOKLIN WHITE RDN, LD

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	DT87249	TX

General Provider Information

NPI Number	:	1255063467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKLIN WHITE RDN, LD

Provider Business Mailing Address
First Line	:	6044 E LOVERS LN APT 10106
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-4962
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6044 E LOVERS LN APT 10106
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-4962
Country	:	US
Telephone Number	:	951-326-9306
Fax Number	:

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

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/27/2022

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