Provider Demographics
NPI:1073847539
Name:SANCEN DE BROWN, LUZ ADRIANA (RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:ADRIANA
Last Name:SANCEN DE BROWN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:LUZ
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:2009 ELM ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3233
Mailing Address - Country:US
Mailing Address - Phone:217-228-0828
Mailing Address - Fax:
Practice Address - Street 1:2009 ELM ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3233
Practice Address - Country:US
Practice Address - Phone:217-228-0828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005141133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic