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Contact Information

BREANNA WILSON, MS, RD, LD
612 SW 25TH CIR
TROUTDALE, OR97060
 Phone: 775-230-3787
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dietitian, Registered

133V00000X 71 Registered Dietitian or Nutrition Professional
Indicates primary specialty

NPI Profile & details for BREANNA WILSON · (Female)

NPI Number 1760737837
Status Active
Credentials MS, RD, LD
Entity Individual
Enumeration date 07/16/2012
Last updated 01/29/2020 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • OR License # 1003583
  • OR License # LD-D-10167267
  • VA License # 1003583
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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