Provider Demographics
NPI:1528830346
Name:KARREN, BRIANNA (RD, LD)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:KARREN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 E SICILY ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4863
Mailing Address - Country:US
Mailing Address - Phone:208-407-1660
Mailing Address - Fax:
Practice Address - Street 1:1297 E SICILY ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-4863
Practice Address - Country:US
Practice Address - Phone:208-407-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-1506133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered