Provider Demographics
NPI:1376782086
Name:BROGAN, RACHEL LEIGH (MS, RD, CEDRD)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:LEIGH
Last Name:BROGAN
Suffix:
Gender:F
Credentials:MS, RD, CEDRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2906 E CULLUMBER ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-6348
Mailing Address - Country:US
Mailing Address - Phone:952-956-4654
Mailing Address - Fax:
Practice Address - Street 1:1825 E NORTHERN AVE STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-3972
Practice Address - Country:US
Practice Address - Phone:952-956-4654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ915609133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered