Provider Demographics
NPI:1356602833
Name:WONDERS, BRICE MARTIN (RD, LDN)
Entity type:Individual
Prefix:
First Name:BRICE
Middle Name:MARTIN
Last Name:WONDERS
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 ZINN RD
Mailing Address - Street 2:
Mailing Address - City:THORNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19372-1131
Mailing Address - Country:US
Mailing Address - Phone:610-384-2211
Mailing Address - Fax:
Practice Address - Street 1:3025 ZINN RD
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1131
Practice Address - Country:US
Practice Address - Phone:610-384-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1010148133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered