Provider Demographics
NPI:1114942513
Name:WARREN, BRENDA SUE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:SUE
Last Name:WARREN
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 DOVER RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-7315
Mailing Address - Country:US
Mailing Address - Phone:850-871-0736
Mailing Address - Fax:
Practice Address - Street 1:6703 W HIGHWAY 98
Practice Address - Street 2:BLDG 387
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32407-7000
Practice Address - Country:US
Practice Address - Phone:850-636-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL631668133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered