Active NPI
Brooke Odendahl
- Registered Dietitian
- Cedar Rapids, IA
National Provider Identifier
1104528744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 099612
- Practice address
- 3500 Dalton Way SW Ste 300
Cedar Rapids, IA 52404-2567 - Phone
- (319) 369-4340
- NPI assigned
- Mar 20, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 099612 | IA | Primary |
Addresses
Primary practice location
3500 Dalton Way SW Ste 300
Cedar Rapids, IA 52404-2567
Mailing address
6325 Muirfield Dr SW
Cedar Rapids, IA 52404-7404
Phone (712) 210-4041
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 099612 | IA | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679270400000",
"number": "1104528744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6325 MUIRFIELD DR SW",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524047404",
"telephone_number": "712-210-4041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3500 DALTON WAY SW STE 300",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524042567",
"telephone_number": "319-369-4340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODENDAHL",
"first_name": "BROOKE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-20",
"last_updated": "2023-03-20",
"certification_date": "2023-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "IA",
"license": "099612",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cedar Rapids, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.