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Individual

BREANNA WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, RD, LD

Contact information

Practice address
612 SW 25TH CIR, TROUTDALE, OR 97060-1891
(775) 230-3787
Mailing address
612 SW 25TH CIR, TROUTDALE, OR 97060-1891

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1003583
OR
133V00000X
Registered Dietitian
1003583
VA
133V00000X
Registered Dietitian
LD-D-10167267
OR

Other

Enumeration date
07/16/2012
Last updated
01/29/2020
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