Provider Demographics
NPI:1053826529
Name:ZIGLER, BROOKE (MPP, RDN, LD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:ZIGLER
Suffix:
Gender:F
Credentials:MPP, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8229 CRABTREE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-7833
Mailing Address - Country:US
Mailing Address - Phone:443-838-4079
Mailing Address - Fax:
Practice Address - Street 1:8229 CRABTREE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-7833
Practice Address - Country:US
Practice Address - Phone:443-838-4079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83035133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered