Provider Demographics
NPI:1033982699
Name:BRIANNA GRANDE NUTRITION
Entity Type:Organization
Organization Name:BRIANNA GRANDE NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:N
Authorized Official - Last Name:GRANDE
Authorized Official - Suffix:
Authorized Official - Credentials:MS RD LDN EP-C
Authorized Official - Phone:330-301-3815
Mailing Address - Street 1:201 ROCKY SLOPE RD APT 609
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3951
Mailing Address - Country:US
Mailing Address - Phone:330-301-3815
Mailing Address - Fax:
Practice Address - Street 1:201 ROCKY SLOPE RD APT 609
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3951
Practice Address - Country:US
Practice Address - Phone:330-301-3815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty