Provider Demographics
NPI:1891906830
Name:NESS, BRANDIE JEAN (RD, LD)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:JEAN
Last Name:NESS
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 1:121 WILLOW DR SW
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376-9769
Mailing Address - Country:US
Mailing Address - Phone:763-497-0244
Mailing Address - Fax:
Practice Address - Street 1:121 WILLOW DR SW
Practice Address - Street 2:
Practice Address - City:SAINT MICHAEL
Practice Address - State:MN
Practice Address - Zip Code:55376-9769
Practice Address - Country:US
Practice Address - Phone:763-497-0244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2400133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered