Provider Demographics
NPI:1942279302
Name:ROHE, BRENDA JEAN (RD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JEAN
Last Name:ROHE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:JEAN
Other - Last Name:HARMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1718 E 4TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3260
Mailing Address - Country:US
Mailing Address - Phone:704-384-7390
Mailing Address - Fax:704-384-5669
Practice Address - Street 1:1718 E 4TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3260
Practice Address - Country:US
Practice Address - Phone:704-384-7390
Practice Address - Fax:704-384-5669
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000116133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2994420Medicare ID - Type Unspecified