Provider Demographics
NPI:1790029932
Name:BROWN, CHRISTA LYNN (RD)
Entity Type:Individual
Prefix:MS
First Name:CHRISTA
Middle Name:LYNN
Last Name:BROWN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CHRISTA
Other - Middle Name:
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 SHARON GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-4317
Mailing Address - Country:US
Mailing Address - Phone:908-217-6371
Mailing Address - Fax:
Practice Address - Street 1:303 SHARON GARDEN CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-4317
Practice Address - Country:US
Practice Address - Phone:908-217-6371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-10
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ136A00000X
NJ1067475133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0990Medicaid