Provider Demographics
NPI:1770291460
Name:HARRIS, BRETHA MICHELLE (RD, RDN)
Entity type:Individual
Prefix:DR
First Name:BRETHA
Middle Name:MICHELLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RD, RDN
Other - Prefix:DR
Other - First Name:B. MICHELLE
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD, RDN
Mailing Address - Street 1:4505 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4713
Mailing Address - Country:US
Mailing Address - Phone:202-503-0158
Mailing Address - Fax:
Practice Address - Street 1:7450 ALBERT RD
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-3035
Practice Address - Country:US
Practice Address - Phone:301-888-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01677133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered