Individual
BROOKE MARIE THEODORAKOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, RD, LD
Contact information
Practice address
1145 IRONHORSE CT, WENTZVILLE, MO 63385-4676
(314) 324-6119
Mailing address
1145 IRONHORSE CT, WENTZVILLE, MO 63385-4676
(314) 324-6119
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2009000717
MO
Other
Enumeration date
12/04/2024
Last updated
12/04/2024
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