Provider Demographics
NPI:1457944621
Name:MORALES, BRIEANNA MARIE (RD)
Entity Type:Individual
Prefix:
First Name:BRIEANNA
Middle Name:MARIE
Last Name:MORALES
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85533-0936
Mailing Address - Country:US
Mailing Address - Phone:928-865-2601
Mailing Address - Fax:928-865-1929
Practice Address - Street 1:253 5TH ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:AZ
Practice Address - Zip Code:85533
Practice Address - Country:US
Practice Address - Phone:928-865-2601
Practice Address - Fax:928-865-1929
Is Sole Proprietor?:No
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86048227133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered