Provider Demographics
NPI:1770278889
Name:BEISMANN, BROOKE (MA, RDN, LD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BEISMANN
Suffix:
Gender:F
Credentials:MA, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 CLIFTON PARK CIR E APT 306
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-1163
Mailing Address - Country:US
Mailing Address - Phone:937-570-5166
Mailing Address - Fax:
Practice Address - Street 1:595 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4681
Practice Address - Country:US
Practice Address - Phone:937-570-5166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006186133V00000X
OHLD.09813133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered