Provider Demographics
NPI:1114911914
Name:NORMAN, MARGARET D (BS, MS)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:D
Last Name:NORMAN
Suffix:
Gender:F
Credentials:BS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-7154
Mailing Address - Country:US
Mailing Address - Phone:360-414-2048
Mailing Address - Fax:360-575-6749
Practice Address - Street 1:600 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3256
Practice Address - Country:US
Practice Address - Phone:360-636-4943
Practice Address - Fax:360-414-7674
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00000517133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8290173Medicaid
OR100437Medicaid
WA8290173Medicaid
WAAB37427Medicare ID - Type UnspecifiedPIN NUMBER - PHMG
WAAB38215Medicare ID - Type UnspecifiedHOSP BASED PIN NUMBER