Provider Demographics
NPI:1215588298
Name:BRANCHE, MARYKATE E (RDN)
Entity Type:Individual
Prefix:MRS
First Name:MARYKATE
Middle Name:E
Last Name:BRANCHE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 STATE ROUTE 57
Mailing Address - Street 2:
Mailing Address - City:PORT MURRAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07865-4045
Mailing Address - Country:US
Mailing Address - Phone:908-455-0072
Mailing Address - Fax:
Practice Address - Street 1:1025 STATE ROUTE 57
Practice Address - Street 2:
Practice Address - City:PORT MURRAY
Practice Address - State:NJ
Practice Address - Zip Code:07865-4045
Practice Address - Country:US
Practice Address - Phone:908-455-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-22
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006504133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered