Callie Anne Lebrun, RD, CD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

3612-29 Issued in WI

Practice address

1710 Lawrence Dr Ste 200
De Pere, WI 54115-9195

Phone

(920) 570-6339

NPI assigned

May 12, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24776/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Evolve LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Appleton, WI
  • NPI 1821541137
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620777600000",
    "number": "1750965992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5871 RONK RD",
            "city": "DENMARK",
            "state": "WI",
            "postal_code": "542089113",
            "telephone_number": "920-615-2778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 LAWRENCE DR STE 200",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541159195",
            "telephone_number": "920-570-6339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEBRUN",
        "first_name": "CALLIE",
        "middle_name": "ANNE",
        "credential": "RD, CD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-12",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WI",
            "license": "3612-29",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "callie@evolvehealing.org",
            "affiliation": "N",
            "endpointDescription": "Work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1710 Lawrence Dr Ste 200",
            "city": "DE Pere",
            "state": "WI",
            "country_code": "US",
            "postal_code": "541159195",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cynthia B Lasecki, MD
• Charles J Latorre, LCSW
• Jessica Lawton
• Ivy E Leasum, NP
• Marie Claude Lebel, OTA
• Carissa Lebsock, BCBA
• Ledge View Nursing Center
• Ell Louis Lee, D.D.S.
• Abigail Lefeber
• Tracy Lynn Legg, PTA

• Registered Dietitian in De Pere, WI
• Providers in De Pere, WI by specialty
• Registered Dietitian in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.