Provider Demographics
NPI:1184417842
Name:BRODBECK, MCKENNA NOEL (RDN, LDN)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:NOEL
Last Name:BRODBECK
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 PLOVER DR UNIT 3A
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-7139
Mailing Address - Country:US
Mailing Address - Phone:717-668-5890
Mailing Address - Fax:
Practice Address - Street 1:35786 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967-6955
Practice Address - Country:US
Practice Address - Phone:302-400-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEDN-0011342133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered