Provider Demographics
NPI:1184239626
Name:CZARNECKI, BROOKE BUSA (RDN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:BUSA
Last Name:CZARNECKI
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BOXWOOD BLVD APT 5324
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-2348
Mailing Address - Country:US
Mailing Address - Phone:315-663-1028
Mailing Address - Fax:
Practice Address - Street 1:1400 BOXWOOD BLVD APT 5324
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2348
Practice Address - Country:US
Practice Address - Phone:315-663-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered