Provider Demographics
NPI:1730416850
Name:THOMPSON, BRENNA MILLER (MS, RD, LD,)
Entity type:Individual
Prefix:MRS
First Name:BRENNA
Middle Name:MILLER
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MS, RD, LD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 LYNDALE AVENUE SOUTH
Mailing Address - Street 2:SUITE 500
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423
Mailing Address - Country:US
Mailing Address - Phone:612-886-3706
Mailing Address - Fax:612-886-3681
Practice Address - Street 1:6625 LYNDALE AVENUE SOUTH
Practice Address - Street 2:SUITE 500
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423
Practice Address - Country:US
Practice Address - Phone:612-886-3706
Practice Address - Fax:612-886-3681
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3058133V00000X
1009309133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered