Provider Demographics
NPI:1023356763
Name:BRANDYWINE AREA NUTRITION, LLC
Entity Type:Organization
Organization Name:BRANDYWINE AREA NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGUES
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:302-761-9702
Mailing Address - Street 1:4 CLERMONT RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3945
Mailing Address - Country:US
Mailing Address - Phone:302-761-9702
Mailing Address - Fax:
Practice Address - Street 1:4 CLERMONT RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3945
Practice Address - Country:US
Practice Address - Phone:302-761-9702
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE0000162133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE491579Medicare PIN