Provider Demographics
NPI:1952679565
Name:BRANZ, ERICA LEIGH (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LEIGH
Last Name:BRANZ
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N GORE AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2315
Mailing Address - Country:US
Mailing Address - Phone:618-304-1530
Mailing Address - Fax:
Practice Address - Street 1:231 W LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2951
Practice Address - Country:US
Practice Address - Phone:314-968-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010011211133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered