Brooke Kathleen Boskovich, RD
Individual provider Active NPI Registered Dietitian · Bend, OR
NPI 1477095370 · NPPES record last updated Nov 8, 2016
Key facts
- NPI
- 1477095370
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Dietitian 133V00000X
- License
- LD-D-10177805 (OR)
- Practice address
- 1750 NE Neff Rd
Guest House
Bend, OR 97701-6111 - Phone
- (541) 980-7659
- NPI assigned
- Nov 8, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD-D-10177805 | OR | MD | Registered Dietitian |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | LD-D-10177805 | OR | Yes |
Addresses
Primary practice location
1750 NE Neff Rd
Guest House
Bend, OR 97701-6111
Mailing address
PO Box 8815
Bend, OR 97708-8815
Phone (541) 980-7659
Other names
- Brooke Kathleen Gray
Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.