Provider Demographics
NPI:1366685638
Name:BOURGOIN, DEBBE A (RD)
Entity Type:Individual
Prefix:
First Name:DEBBE
Middle Name:A
Last Name:BOURGOIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223-1442
Mailing Address - Country:US
Mailing Address - Phone:609-335-6084
Mailing Address - Fax:609-545-8279
Practice Address - Street 1:110 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223-1442
Practice Address - Country:US
Practice Address - Phone:609-335-6084
Practice Address - Fax:609-545-8279
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered