Provider Demographics
NPI:1760282073
Name:KING-BRUSCHI, STEPHANIE MARIE (NUTRITIONALTHERAPIST)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:KING-BRUSCHI
Suffix:
Gender:
Credentials:NUTRITIONALTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STRADELLO SAN GIROLAMO
Mailing Address - Street 2:#4
Mailing Address - City:PARMA
Mailing Address - State:PARMA
Mailing Address - Zip Code:43121
Mailing Address - Country:IT
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:STRADELLO SAN GIROLAMO
Practice Address - Street 2:#4
Practice Address - City:PARMA
Practice Address - State:PARMA
Practice Address - Zip Code:43121
Practice Address - Country:IT
Practice Address - Phone:503-890-8329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach