Provider Demographics
NPI:1548411994
Name:BRECH, DETRI M (PHD, RD, LD, CDE)
Entity Type:Individual
Prefix:DR
First Name:DETRI
Middle Name:M
Last Name:BRECH
Suffix:
Gender:F
Credentials:PHD, RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PINNACLE DR
Mailing Address - Street 2:
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-3618
Mailing Address - Country:US
Mailing Address - Phone:870-246-9275
Mailing Address - Fax:
Practice Address - Street 1:117 PINNACLE DR
Practice Address - Street 2:
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-3618
Practice Address - Country:US
Practice Address - Phone:870-246-9275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR698613133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered