Provider Demographics
NPI:1215173117
Name:FRUSHON, CHRISTOPHER (RD, LDN)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:FRUSHON
Suffix:
Gender:M
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 UNION ST
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17963-1424
Mailing Address - Country:US
Mailing Address - Phone:570-794-5007
Mailing Address - Fax:570-915-6525
Practice Address - Street 1:12 UNION ST
Practice Address - Street 2:
Practice Address - City:PINE GROVE
Practice Address - State:PA
Practice Address - Zip Code:17963-1424
Practice Address - Country:US
Practice Address - Phone:570-794-5007
Practice Address - Fax:570-915-6525
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-23
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004083133V00000X, 133VN1006X, 133VN1004X, 133VN1005X, 133N00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education