Provider Demographics
NPI:1437457454
Name:CHAMBERS-KOZAROV, YVONNE B (RD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:B
Last Name:CHAMBERS-KOZAROV
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:B
Other - Last Name:CHAMBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:141 LONGWATER DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-9147
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:781-878-3989
Practice Address - Street 1:143 LONGWATER DRIVE
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-9147
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:781-878-3989
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
MA3086133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASS0080OtherBCBSMA
1437457454OtherFLLON
1437457454OtherFLLON
MASS0080OtherBCBSMA