Provider Demographics
NPI:1194102780
Name:BREHM, MICHELLE (MFCS, RD, LD)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:BREHM
Suffix:
Gender:F
Credentials:MFCS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JAKOBSTR. 31
Mailing Address - Street 2:
Mailing Address - City:RAUNHEIM
Mailing Address - State:HESSEN
Mailing Address - Zip Code:65479
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:JAKOBSTR. 31
Practice Address - Street 2:
Practice Address - City:RAUNHEIM
Practice Address - State:HESSEN
Practice Address - Zip Code:65479
Practice Address - Country:DE
Practice Address - Phone:011491523-454-9968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-03
Last Update Date:2015-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1094401133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered