MEDICARE: BRIANNA LANDIS MS, RD, CDN

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

General Provider Information

NPI Number	:	1457130015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA LANDIS MS, RD, CDN

Provider Business Mailing Address
First Line	:	2716 SW SYLVAN HEIGHTS DR
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-1751
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2716 SW SYLVAN HEIGHTS DR
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98106-1751
Country	:	US
Telephone Number	:	303-518-7150
Fax Number	:

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

Provider Enumeration Date	:	09/25/2023
Last Update Date	:	09/25/2023

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