Provider Demographics
NPI:1881062958
Name:BAILDON, BREANNA M (RDN)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:M
Last Name:BAILDON
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:
Other - Last Name:LEAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:15308 136TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9241
Mailing Address - Country:US
Mailing Address - Phone:253-227-8284
Mailing Address - Fax:206-350-2612
Practice Address - Street 1:10210 123RD STREET CT E STE D
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2634
Practice Address - Country:US
Practice Address - Phone:253-227-4899
Practice Address - Fax:206-350-2612
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 60590032133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered