Provider Demographics
NPI:1750541314
Name:BROWN, ANGELA KRISTINE (RD, CDN)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:KRISTINE
Last Name:BROWN
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 W PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-1432
Mailing Address - Country:US
Mailing Address - Phone:315-868-6170
Mailing Address - Fax:
Practice Address - Street 1:13 W PROSPECT ST
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-1432
Practice Address - Country:US
Practice Address - Phone:315-868-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006136133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered