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General NPI Number Information
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NPI Number | 1306368253
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Entity Type | Individual
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Provider Name | SALLY C BROSSMAN RD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 10/07/2020
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Provider Practice Location Address
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Address Line | 2015 TECHNOLOGY PKWY
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City | MECHANICSBURG
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State | PA
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Zip | 17050-9414
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Country | US
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Telephone | 717-791-2546
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Fax | 717-221-5299
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Provider Business Mailing Address
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Address Line | 409 S 2ND ST STE 2F
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City | HARRISBURG
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State | PA
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Zip | 17104-1612
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Country | US
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Telephone | 717-657-7301
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Fax | 717-657-7390
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 136A00000X
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Taxonomy Name | Registered Dietetic Technician
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License Number | DN004568
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DN004568
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License Number State | PA
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