Provider Demographics
NPI:1841781457
Name:SCHOONENBERG, BROOKE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:SCHOONENBERG
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 1:9637 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2632
Mailing Address - Country:US
Mailing Address - Phone:225-924-8313
Mailing Address - Fax:
Practice Address - Street 1:9637 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2632
Practice Address - Country:US
Practice Address - Phone:225-924-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2488133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered