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Individual
SALLY C BROSSMAN
Active
Individual
SALLY C BROSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DN004568
PA
136A00000X
Registered Dietetic Technician
DN004568
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103344993
—
PA
Enumeration date
07/12/2017
Last updated
10/07/2020
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