Provider Demographics
NPI:1093304420
Name:WEST, BROOKE (RDN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WEST
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-3227
Mailing Address - Country:US
Mailing Address - Phone:571-439-0881
Mailing Address - Fax:
Practice Address - Street 1:2711 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-3227
Practice Address - Country:US
Practice Address - Phone:571-439-0881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005244133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered