Provider Demographics
NPI:1225785561
Name:BRANZ NUTRITION COUNSELING
Entity Type:Organization
Organization Name:BRANZ NUTRITION COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:BRANZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LDN, CEDRD
Authorized Official - Phone:618-304-1530
Mailing Address - Street 1:1228 NATALYNS TRCE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IL
Mailing Address - Zip Code:62254-1849
Mailing Address - Country:US
Mailing Address - Phone:618-304-1530
Mailing Address - Fax:
Practice Address - Street 1:787 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1960
Practice Address - Country:US
Practice Address - Phone:618-304-1530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty