Provider Demographics
NPI:1194125385
Name:BRUNER, VICTORIA (MS, RD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BRUNER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WINTER SPORT LN STE 155
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-8147
Mailing Address - Country:US
Mailing Address - Phone:802-999-9207
Mailing Address - Fax:802-735-2361
Practice Address - Street 1:20 WINTER SPORT LN STE 155
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8147
Practice Address - Country:US
Practice Address - Phone:802-999-9207
Practice Address - Fax:802-735-2361
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered