Provider Demographics
NPI:1932983673
Name:CUMMING, BRENNA ANNE (RD, LN)
Entity Type:Individual
Prefix:MS
First Name:BRENNA
Middle Name:ANNE
Last Name:CUMMING
Suffix:
Gender:F
Credentials:RD, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 ASPEN RDG
Mailing Address - Street 2:
Mailing Address - City:GALLATIN GATEWAY
Mailing Address - State:MT
Mailing Address - Zip Code:59730-8598
Mailing Address - Country:US
Mailing Address - Phone:831-320-0511
Mailing Address - Fax:
Practice Address - Street 1:14 S WILLSON AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6232
Practice Address - Country:US
Practice Address - Phone:406-451-7370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT129109133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered