Provider Demographics
NPI:1114374717
Name:ELLIOTT, BRIANNA CECILE (RDN)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:CECILE
Last Name:ELLIOTT
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 1:2500 BLOOMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-3920
Mailing Address - Country:US
Mailing Address - Phone:612-767-7332
Mailing Address - Fax:612-872-0886
Practice Address - Street 1:2500 BLOOMINGTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-3920
Practice Address - Country:US
Practice Address - Phone:612-767-7332
Practice Address - Fax:612-872-0886
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3605133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered