Provider Demographics
NPI:1750146395
Name:GRIGGS, BROOKE JEANNE (RDN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:JEANNE
Last Name:GRIGGS
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 1:840 WATERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8046
Mailing Address - Country:US
Mailing Address - Phone:201-314-1891
Mailing Address - Fax:
Practice Address - Street 1:840 WATERSTONE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8046
Practice Address - Country:US
Practice Address - Phone:201-314-1891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007594133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered