Provider Demographics
NPI:1952912446
Name:STORM, BRITTA L (CN)
Entity Type:Individual
Prefix:
First Name:BRITTA
Middle Name:L
Last Name:STORM
Suffix:
Gender:F
Credentials:CN
Other - Prefix:
Other - First Name:BRITTA
Other - Middle Name:L
Other - Last Name:YOUNGQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4621 N VISSCHER ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407-2020
Mailing Address - Country:US
Mailing Address - Phone:253-273-3896
Mailing Address - Fax:
Practice Address - Street 1:1002 39TH AVE SW STE 200
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3813
Practice Address - Country:US
Practice Address - Phone:855-328-4543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61035734133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist