Provider Demographics
NPI:1558334755
Name:BREEN, LORRAINE RUPP (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:RUPP
Last Name:BREEN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 CHARLES GREEN SQ
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-6036
Mailing Address - Country:US
Mailing Address - Phone:703-298-6270
Mailing Address - Fax:
Practice Address - Street 1:WALTER REED ARMY MEDICAL CENTER
Practice Address - Street 2:6900 GEORGIA AVENUE, NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-2020
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
497689133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered