Provider Demographics
NPI:1699215517
Name:BRIGHAM, SUNNY (CNS)
Entity Type:Individual
Prefix:
First Name:SUNNY
Middle Name:
Last Name:BRIGHAM
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-6406
Mailing Address - Country:US
Mailing Address - Phone:682-334-2411
Mailing Address - Fax:817-330-6414
Practice Address - Street 1:1945 6TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-6406
Practice Address - Country:US
Practice Address - Phone:682-334-2411
Practice Address - Fax:817-330-6414
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist