Provider Demographics
NPI:1811406002
Name:BRAMMELL, VIRGINIA L (RD, LD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:L
Last Name:BRAMMELL
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 RIVER SHORE DR APT 138
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2782
Mailing Address - Country:US
Mailing Address - Phone:502-396-8588
Mailing Address - Fax:
Practice Address - Street 1:1500 RIVER SHORE DR APT 138
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2782
Practice Address - Country:US
Practice Address - Phone:502-396-8588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86021525133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered