Healthcare Provider Details

I. General information

NPI: 1215173117
Provider Name (Legal Business Name): CHRISTOPHER FRUSHON R.D., L.D.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2008
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 UNION ST
PINE GROVE PA
17963-1424
US

IV. Provider business mailing address

12 UNION ST
PINE GROVE PA
17963-1424
US

V. Phone/Fax

Practice location:
  • Phone: 570-794-5007
  • Fax: 570-915-6525
Mailing address:
  • Phone: 570-794-5007
  • Fax: 570-915-6525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN004083
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDN004083
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDN004083
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License NumberDN004083
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDN004083
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberDN004083
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: