Provider Demographics
NPI:1508687062
Name:MORGAN, BRENDA SIEBOLD (MBA, MS, RDN, LD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:SIEBOLD
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MBA, MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 STONE HILL CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3659
Mailing Address - Country:US
Mailing Address - Phone:210-842-3008
Mailing Address - Fax:
Practice Address - Street 1:11 STONE HILL CT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3659
Practice Address - Country:US
Practice Address - Phone:210-842-3008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT91116133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered