Provider Demographics
NPI:1386823862
Name:BORYS, ERICA MARIE (RD, CD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIE
Last Name:BORYS
Suffix:
Gender:F
Credentials:RD, CD
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:MARIE
Other - Last Name:WOJCIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, CD
Mailing Address - Street 1:17255 14B RD
Mailing Address - Street 2:
Mailing Address - City:CULVER
Mailing Address - State:IN
Mailing Address - Zip Code:46511-9020
Mailing Address - Country:US
Mailing Address - Phone:574-842-2213
Mailing Address - Fax:
Practice Address - Street 1:17255 14B RD
Practice Address - Street 2:
Practice Address - City:CULVER
Practice Address - State:IN
Practice Address - Zip Code:46511-9020
Practice Address - Country:US
Practice Address - Phone:574-842-2213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001483A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered