Provider Demographics
NPI:1013487818
Name:HUXFORD, BRIANNE (RD)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:
Last Name:HUXFORD
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 E SPRINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4595
Mailing Address - Country:US
Mailing Address - Phone:765-592-6606
Mailing Address - Fax:
Practice Address - Street 1:401 OHIO ST STE B1
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3529
Practice Address - Country:US
Practice Address - Phone:812-917-4229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86102377133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered