1194185603 NPI number — MS. NORMA STEINHARDT BOUR R.D.

Table of content: MS. NORMA STEINHARDT BOUR R.D. (NPI 1194185603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194185603 NPI number — MS. NORMA STEINHARDT BOUR R.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOUR
Provider First Name:
NORMA
Provider Middle Name:
STEINHARDT
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
R.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEINHARDT
Provider Other First Name:
NORMA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194185603
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3299 GULL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49048-1281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-373-5382
Provider Business Mailing Address Fax Number:
269-373-5227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3299 GULL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49048-1281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-373-5382
Provider Business Practice Location Address Fax Number:
269-373-5227
Provider Enumeration Date:
02/25/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 679885 . This is a "REGISTRATION NUMBER COMMISSION ON DIETETIC REGISTRATION" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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