Breanna Wilson, MS, RD, LD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

1003583 Issued in OR

Practice address

612 SW 25TH Cir
Troutdale, OR 97060-1891

Phone

(775) 230-3787

NPI assigned

Jul 16, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• CMB Nutrition & Wellness

  • Registered Dietitian
  • Troutdale, OR
  • NPI 1780217018

  Dietitian, Registered

  NPD Authorized official

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

{
    "created_epoch": "1342396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1760737837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 SW 25TH CIR",
            "city": "TROUTDALE",
            "state": "OR",
            "postal_code": "970601891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 SW 25TH CIR",
            "city": "TROUTDALE",
            "state": "OR",
            "postal_code": "970601891",
            "telephone_number": "775-230-3787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "BREANNA",
        "credential": "MS, RD, LD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-16",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "LD-D-10167267",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "VA",
            "license": "1003583",
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "OR",
            "license": "1003583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine A Whitaker, FNP
• Emily J White, CRT
• Kyra Wiens, DC
• Bonita Lagina Wilcox, ND
• Shellie Louise Williams, LMT
• Meghan Winter
• Million Bekele Wolde
• Robert Yancey, RPH MBA
• Youth Unlimited Inc.
• Youth Unlimited Inc.

• Registered Dietitian in Troutdale, OR
• Providers in Troutdale, OR by specialty
• Registered Dietitian in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; 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.