Provider Demographics
NPI:1679798722
Name:BROWN, STEPHANIE (RD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307B RODRIGO ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2029
Mailing Address - Country:US
Mailing Address - Phone:713-202-3855
Mailing Address - Fax:866-899-5525
Practice Address - Street 1:6307B RODRIGO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2029
Practice Address - Country:US
Practice Address - Phone:713-202-3855
Practice Address - Fax:866-899-5525
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV933141133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX933141OtherCOMMISSION ON DIETETIC REGISTRATION
TXDT81005OtherTEXAS STATE BOARD OF EXAMINERS OF DIETITIANS