Organization
CMB NUTRITION & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BREANNA WILSON MS, RD, LD (REGISTERED DIETITIAN/PART OWNER)
(775) 230-3787
Entity
Organization
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
—
—
Other
Enumeration date
02/14/2020
Last updated
02/14/2020
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