Provider Demographics
NPI:1356841340
Name:BRUINOOGE, BRIANA LYNN
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:LYNN
Last Name:BRUINOOGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 ISLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4217
Mailing Address - Country:US
Mailing Address - Phone:603-897-9340
Mailing Address - Fax:
Practice Address - Street 1:230 LAFAYETTE RD STE 13
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5465
Practice Address - Country:US
Practice Address - Phone:888-964-1975
Practice Address - Fax:877-743-5351
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0935133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH86092789OtherCDR