Provider Demographics
NPI:1992315576
Name:CROTTY, BROOKE ERIN (RDN)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ERIN
Last Name:CROTTY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21716 S PRYOR RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-8188
Mailing Address - Country:US
Mailing Address - Phone:816-286-7517
Mailing Address - Fax:
Practice Address - Street 1:21716 S PRYOR RD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080-8188
Practice Address - Country:US
Practice Address - Phone:816-286-7517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered