Provider Demographics
NPI:1558463141
Name:BRECHT, CHRISTINA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BRECHT
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 1179
Mailing Address - Street 2:
Mailing Address - City:CRESCO
Mailing Address - State:PA
Mailing Address - Zip Code:18326-9764
Mailing Address - Country:US
Mailing Address - Phone:570-629-9672
Mailing Address - Fax:570-629-6355
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-2816
Practice Address - Country:US
Practice Address - Phone:570-426-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001801133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN001801OtherLICENSE NUMBER
PADN001801OtherLICENSE NUMBER