=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841985280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERICKA KOFFEL NUTRITION, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2023
-----------------------------------------------------
Last Update Date | 04/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2925 WILLIAM PENN HWY STE 306
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18045-5283
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-554-0124
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 DOGWOOD ST
-----------------------------------------------------
City | BALLY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19503-9684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-903-1866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGISTERED DIETITIAN NUTRITIONIST
-----------------------------------------------------
Name | ERICKA LINDSAY KOFFEL
-----------------------------------------------------
Credential | RDN, LDN, CHWC
-----------------------------------------------------
Telephone | 609-903-1866
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------