Provider Demographics
NPI:1427347772
Name:BOCCIA, ERIN (RD, LD, CDE)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:BOCCIA
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MEDICAL CENTER DR
Mailing Address - Street 2:PO BOX 308
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-8780
Mailing Address - Country:US
Mailing Address - Phone:316-804-6147
Mailing Address - Fax:
Practice Address - Street 1:700 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 101
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-9013
Practice Address - Country:US
Practice Address - Phone:316-804-6147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1378133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered