Provider Demographics
NPI:1528431319
Name:O'BRYAN, BRITTANY LAINE (DIETITIAN)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LAINE
Last Name:O'BRYAN
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:LAINE
Other - Last Name:SONNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DIETITIAN
Mailing Address - Street 1:15790 PAUL VEGA MD DR
Mailing Address - Street 2:NUTRITIONAL SERVICES
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1434
Mailing Address - Country:US
Mailing Address - Phone:985-230-6772
Mailing Address - Fax:985-230-6563
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:NUTRITIONAL SERVICES
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-6772
Practice Address - Fax:985-230-6563
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2293133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2293OtherDIETITIAN CERTIFICATION NUMBER