Provider Demographics
NPI:1376389585
Name:JURSS, BRIANNA (RD)
Entity type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:
Last Name:JURSS
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 1:817 GLENLYON LN
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074-9691
Mailing Address - Country:US
Mailing Address - Phone:224-221-1339
Mailing Address - Fax:
Practice Address - Street 1:116 W GRAND AVE STE 210
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074-2242
Practice Address - Country:US
Practice Address - Phone:224-221-1339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI86371856133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered