Provider Demographics
NPI:1326069287
Name:BRIZEE, LORI SUZANNE (RD)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:SUZANNE
Last Name:BRIZEE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 SW13TH STREET STE 101
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702
Mailing Address - Country:US
Mailing Address - Phone:541-306-6801
Mailing Address - Fax:541-312-4670
Practice Address - Street 1:516 SW 13TH ST
Practice Address - Street 2:STE 101
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3442
Practice Address - Country:US
Practice Address - Phone:541-388-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR760133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8261778Medicaid