1255770954 NPI number — MARGARET ELIZABETH BRUTICO REGISTERED DIETITIAN

Table of content: MARGARET ELIZABETH BRUTICO REGISTERED DIETITIAN (NPI 1255770954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255770954 NPI number — MARGARET ELIZABETH BRUTICO REGISTERED DIETITIAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUTICO
Provider First Name:
MARGARET
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED DIETITIAN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRITTAIN
Provider Other First Name:
MARGARET
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
REGISTERED DIETITIAN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255770954
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N ACADEMY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17822-4903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-271-6144
Provider Business Mailing Address Fax Number:
570-271-6578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 KEYSTONE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18640-6153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-552-1852
Provider Business Practice Location Address Fax Number:
570-214-1525
Provider Enumeration Date:
06/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  DN004953 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com