Provider Demographics
NPI:1932549201
Name:BRUST, CAROLINE O'STEEN (MPH, RDN, LD, CHES)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:O'STEEN
Last Name:BRUST
Suffix:
Gender:F
Credentials:MPH, RDN, LD, CHES
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:ALEXANDRA
Other - Last Name:O'STEEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2036 BLUE HERON CIR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6853
Mailing Address - Country:US
Mailing Address - Phone:205-218-4366
Mailing Address - Fax:
Practice Address - Street 1:2036 BLUE HERON CIR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6853
Practice Address - Country:US
Practice Address - Phone:205-218-4366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003830133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered