Provider Demographics
NPI:1538935929
Name:SMITH, BRIANNA MARIE (RD, MS)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 S BROAD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-2802
Mailing Address - Country:US
Mailing Address - Phone:484-221-3112
Mailing Address - Fax:
Practice Address - Street 1:701 OSTRUM ST STE 303
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1152
Practice Address - Country:US
Practice Address - Phone:484-526-3900
Practice Address - Fax:484-526-3908
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007486133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered