Provider Demographics
NPI:1639445216
Name:LAI, BREANA G (RD,LDN)
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:G
Last Name:LAI
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 MARKET ST
Mailing Address - Street 2:#16
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-9358
Mailing Address - Country:US
Mailing Address - Phone:919-210-1144
Mailing Address - Fax:
Practice Address - Street 1:1340 ENVIRON WAY STE 1340
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-4430
Practice Address - Country:US
Practice Address - Phone:919-210-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003947133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered