Provider Demographics
NPI:1174829873
Name:BOURNE, MEGHAN ELIZABETH (RD, LDN, CDOE, CDCES)
Entity Type:Individual
Prefix:MISS
First Name:MEGHAN
Middle Name:ELIZABETH
Last Name:BOURNE
Suffix:
Gender:F
Credentials:RD, LDN, CDOE, CDCES
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:ELIZABETH
Other - Last Name:MARTORANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LDN, CDOE, CDCES
Mailing Address - Street 1:450 VETERANS MEMORIAL PKWY STE 8C
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-5300
Mailing Address - Country:US
Mailing Address - Phone:401-396-9331
Mailing Address - Fax:401-396-9369
Practice Address - Street 1:450 VETERANS MEMORIAL PKWY STE 8C
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-5300
Practice Address - Country:US
Practice Address - Phone:401-396-9331
Practice Address - Fax:401-396-9369
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000003089133V00000X
RILDN00684133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered