Provider Demographics
NPI:1639809064
Name:BRUBAKER, ANN (RD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 LINDSAY ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3420
Mailing Address - Country:US
Mailing Address - Phone:513-403-3640
Mailing Address - Fax:
Practice Address - Street 1:44075 PIPELINE PLZ STE 300
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5889
Practice Address - Country:US
Practice Address - Phone:703-651-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered