NPI 1679988810 · live from the CMS NPI Registry
Shannon C Brueggemann, MS, RDN, LDN
Dietitian, Registered in Saint Louis, MO. National Provider Identifier 1679988810, active.
NPI record
| NPI | 1679988810 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 3660 Vista Ave, Second Floor, Saint Louis, MO 63110 |
| Practice phone | 314-977-6142 |
| Enumerated | June 26, 2014 |
| Last updated | June 26, 2014 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 2004020871 (MO) |
| Dietitian, Registered | 133V00000X | 164.003871 (IL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.