Provider Demographics
NPI:1194185603
Name:BOUR, NORMA STEINHARDT (RD)
Entity Type:Individual
Prefix:MS
First Name:NORMA
Middle Name:STEINHARDT
Last Name:BOUR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:NORMA
Other - Middle Name:JEAN
Other - Last Name:STEINHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3299 GULL RD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1281
Mailing Address - Country:US
Mailing Address - Phone:269-373-5382
Mailing Address - Fax:269-373-5227
Practice Address - Street 1:3299 GULL RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1281
Practice Address - Country:US
Practice Address - Phone:269-373-5382
Practice Address - Fax:269-373-5227
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL679885OtherREGISTRATION NUMBER COMMISSION ON DIETETIC REGISTRATION