Provider Demographics
NPI:1093482416
Name:ROGERS, BRITTANY (RD)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:ROMAN-GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:140 VISTA VIEW PL
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4728
Mailing Address - Country:US
Mailing Address - Phone:845-532-7280
Mailing Address - Fax:
Practice Address - Street 1:35605 BEECHING LN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-2517
Practice Address - Country:US
Practice Address - Phone:845-532-7280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD09109133V00000X
TXDT86526133V00000X
WADI60911556133V00000X
DCDI00001063133V00000X
IL164.00752133V00000X
ND1185133V00000X
NY7387133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered