Provider Demographics
NPI:1598483182
Name:BRANTON, BRITTNI
Entity Type:Individual
Prefix:
First Name:BRITTNI
Middle Name:
Last Name:BRANTON
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:N3408 TIPPERARY RD
Mailing Address - Street 2:
Mailing Address - City:POYNETTE
Mailing Address - State:WI
Mailing Address - Zip Code:53955-9253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:N3408 TIPPERARY RD
Practice Address - Street 2:
Practice Address - City:POYNETTE
Practice Address - State:WI
Practice Address - Zip Code:53955-9253
Practice Address - Country:US
Practice Address - Phone:920-946-5949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4380133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist