Provider Demographics
NPI:1932357720
Name:BRINN, CYNTHIA L
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:BRINN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 SQUALICUM PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1898
Mailing Address - Country:US
Mailing Address - Phone:360-734-5400
Mailing Address - Fax:360-756-3552
Practice Address - Street 1:2901 SQUALICUM PARKWAY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1898
Practice Address - Country:US
Practice Address - Phone:360-734-5400
Practice Address - Fax:360-756-3552
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000391133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI00000391OtherWA LICENSE