Provider Demographics
NPI:1063946028
Name:BRUHN-DANELLO, ELIZABETH BENTLEY (RD,LD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BENTLEY
Last Name:BRUHN-DANELLO
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:BENTLEY
Other - Last Name:BRUHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:836 EAST 65TH STREET,
Mailing Address - Street 2:MEDICAL ARTS #4
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:836 EAST 65TH STREET,
Practice Address - Street 2:MEDICAL ARTS #4
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-819-6146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86013919133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered