Brenna St John, | |
1200 W Fairview St, Colfax, WA 99111-9552 | |
(509) 397-5743 | |
(509) 397-5763 |
Full Name | Brenna St John |
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Gender | Female |
Speciality | Dietitian, Registered |
Location | 1200 W Fairview St, Colfax, Washington |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1235604935 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | 60898597 (Washington) | Primary |
Provider Name | Public Hospital District #1-a Of Whitman County |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1366446767 PECOS PAC ID: 8325934987 Enrollment ID: O20040223000506 |
Provider Name | Public Hospital District No 3 Of Whitman County |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1922009448 PECOS PAC ID: 7719875020 Enrollment ID: O20040309000090 |
Provider Name | Public Hospital District No 3 Of Whitman County |
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Provider Type | Part A Provider - Critical Access Hospital |
Provider Identifiers | NPI Number: 1922009448 PECOS PAC ID: 7719875020 Enrollment ID: O20080212000301 |
Mailing Address | Practice Location Address |
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Brenna St John, Po Box 1081, Tekoa, WA 99033-1081 Ph: (509) 710-1286 | Brenna St John, 1200 W Fairview St, Colfax, WA 99111-9552 Ph: (509) 397-5743 |
Marissa Rudley, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1200 W Fairview St, Colfax, WA 99111 Phone: 509-397-5743 | |
Mrs. Maria Grace Mcwade, RD Dietitian Medicare: Not Enrolled in Medicare Practice Location: 1200 W Fairview St, Colfax, WA 99111 Phone: 509-397-3435 |