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NPI Code Detail

MEDICARE: LAUREN BRERETON RD

MEDICARE: LAUREN BRERETON 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
1133V00000XRegistered Dietitian2977TN

General Provider Information

NPI Number : 1497211254
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN BRERETON RD
Provider Business Mailing Address
First Line : 3039 COTULLA CV
Second Line :
City : BARTLETT
State : TN
Zip : 38133-3912
Country : US
Telephone Number : 253-720-6137
Fax Number :
Provider Business Practice Location Address
First Line : 1314 PEABODY AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-3500
Country : US
Telephone Number : 253-720-6137
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2019
Last Update Date : 02/18/2019

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