Provider Demographics
NPI:1700459211
Name:BRESEMANN, BECCA (RD, LD)
Entity Type:Individual
Prefix:
First Name:BECCA
Middle Name:
Last Name:BRESEMANN
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12749 JOHNSON LN STE A
Mailing Address - Street 2:
Mailing Address - City:MANCHACA
Mailing Address - State:TX
Mailing Address - Zip Code:78652-3550
Mailing Address - Country:US
Mailing Address - Phone:512-731-2015
Mailing Address - Fax:833-857-1951
Practice Address - Street 1:589 N FM 1626 STE 307
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-3861
Practice Address - Country:US
Practice Address - Phone:512-731-2015
Practice Address - Fax:833-857-1951
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86067133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered