Provider Demographics
NPI:1902147614
Name:SULLIVAN, BRITNI LORENA (RD)
Entity Type:Individual
Prefix:
First Name:BRITNI
Middle Name:LORENA
Last Name:SULLIVAN
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 1:1160 VARNUM ST NE STE 300
Mailing Address - Street 2:DEPAUL BUILDING
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2103
Mailing Address - Country:US
Mailing Address - Phone:202-534-4241
Mailing Address - Fax:202-448-4080
Practice Address - Street 1:1160 VARNUM ST NE STE 300
Practice Address - Street 2:DEPAUL BUILDING
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2103
Practice Address - Country:US
Practice Address - Phone:202-534-4241
Practice Address - Fax:202-448-4080
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDI100000416133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered