Provider Demographics
NPI:1295071215
Name:BROMM, ANNE KATHRYN (RD CNSC LDN)
Entity type:Individual
Prefix:MRS
First Name:ANNE KATHRYN
Middle Name:
Last Name:BROMM
Suffix:
Gender:F
Credentials:RD CNSC LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:18922-0415
Mailing Address - Country:US
Mailing Address - Phone:215-794-5552
Mailing Address - Fax:
Practice Address - Street 1:1648 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8001
Practice Address - Country:US
Practice Address - Phone:215-938-3392
Practice Address - Fax:215-938-4336
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001843133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered