Provider Demographics
NPI:1245714195
Name:BERGER, BRITTNI DIANE (RD)
Entity type:Individual
Prefix:MRS
First Name:BRITTNI
Middle Name:DIANE
Last Name:BERGER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:BRITTNI
Other - Middle Name:DIANE
Other - Last Name:SPROUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1734 N PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-7992
Mailing Address - Country:US
Mailing Address - Phone:131-683-3778
Mailing Address - Fax:
Practice Address - Street 1:1734 N PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-7992
Practice Address - Country:US
Practice Address - Phone:131-683-3778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86014339133VN1005X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal