Provider Demographics
NPI:1477993616
Name:BEASLEY, BROOKE DARLENE (MS)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:DARLENE
Last Name:BEASLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11720 97TH LN NE
Mailing Address - Street 2:# A408
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-8958
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11720 97TH LN NE
Practice Address - Street 2:# A408
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-8958
Practice Address - Country:US
Practice Address - Phone:713-882-8153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist