Provider Demographics
NPI:1215688007
Name:BRAUNING, BLAKE (MS,RD,CSSD,LD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:BRAUNING
Suffix:
Gender:M
Credentials:MS,RD,CSSD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 BELMONT GREEN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-4362
Mailing Address - Country:US
Mailing Address - Phone:513-846-0368
Mailing Address - Fax:
Practice Address - Street 1:4500 STUART ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29207-5700
Practice Address - Country:US
Practice Address - Phone:803-751-2169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered