Provider Demographics
NPI:1639892144
Name:DENTON, BRIANNA DANIELLE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:DANIELLE
Last Name:DENTON
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 1:818 ARGYLE AVE
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1259
Mailing Address - Country:US
Mailing Address - Phone:815-343-3854
Mailing Address - Fax:
Practice Address - Street 1:11600 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:MERRIONETTE PARK
Practice Address - State:IL
Practice Address - Zip Code:60803-6307
Practice Address - Country:US
Practice Address - Phone:708-272-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008787133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered