Provider Demographics
NPI:1588428874
Name:ZACK, BRITTNEY A (MS/RDN)
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:A
Last Name:ZACK
Suffix:
Gender:F
Credentials:MS/RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 23RD ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-3472
Mailing Address - Country:US
Mailing Address - Phone:724-880-0964
Mailing Address - Fax:
Practice Address - Street 1:1011 23RD ST APT 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-3472
Practice Address - Country:US
Practice Address - Phone:724-880-0964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1063680133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered