Provider Demographics
NPI:1467836460
Name:BRASCH, ERIN (RD, LD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BRASCH
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2093 HENRY TECKLENBURG DR STE 201E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5741
Mailing Address - Country:US
Mailing Address - Phone:843-402-1340
Mailing Address - Fax:843-402-1236
Practice Address - Street 1:2093 HENRY TECKLENBURG DR STE 201E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5741
Practice Address - Country:US
Practice Address - Phone:843-402-1340
Practice Address - Fax:843-402-1236
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1333133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1851361778OtherNPI