Provider Demographics
NPI:1407186133
Name:KREBS, BRANDON (BS RD LDN)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:KREBS
Suffix:
Gender:M
Credentials:BS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 OAK ST.
Mailing Address - Street 2:LONGFELLOW SPORTS CLUB
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760
Mailing Address - Country:US
Mailing Address - Phone:508-653-4633
Mailing Address - Fax:508-650-4986
Practice Address - Street 1:203 OAK ST.
Practice Address - Street 2:LONGFELLOW SPORTS CLUB
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-0000
Practice Address - Country:US
Practice Address - Phone:508-653-4633
Practice Address - Fax:508-650-4986
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered