Provider Demographics
NPI:1790255206
Name:SAWICKI, BROOKE (MS, RD, LDN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:SAWICKI
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 HOSPITAL DR STE 304
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5862
Mailing Address - Country:US
Mailing Address - Phone:410-553-8146
Mailing Address - Fax:410-553-8180
Practice Address - Street 1:305 HOSPITAL DR STE 304
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5862
Practice Address - Country:US
Practice Address - Phone:410-553-8146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4111133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered