Provider Demographics
NPI:1114278215
Name:BRAUN, MARLEY (RD)
Entity Type:Individual
Prefix:
First Name:MARLEY
Middle Name:
Last Name:BRAUN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARLEY
Other - Middle Name:
Other - Last Name:PEALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1946 NW 97TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-2435
Mailing Address - Country:US
Mailing Address - Phone:434-249-2445
Mailing Address - Fax:
Practice Address - Street 1:911 N 145TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-6522
Practice Address - Country:US
Practice Address - Phone:206-604-4707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60310837133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered