Provider Demographics
NPI:1750098893
Name:HARR, BREANNA (RD, CEDS)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:HARR
Suffix:
Gender:F
Credentials:RD, CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 GARFIELD ST APT 307
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-2740
Mailing Address - Country:US
Mailing Address - Phone:720-635-6203
Mailing Address - Fax:
Practice Address - Street 1:1366 GARFIELD ST APT 307
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-2740
Practice Address - Country:US
Practice Address - Phone:720-635-6203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86107355133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered