Provider Demographics
NPI:1508637240
Name:BOURNAS, MARIA (RDN,LDN)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:BOURNAS
Suffix:
Gender:F
Credentials:RDN,LDN
Other - Prefix:MISS
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:PROVIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 FARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-2502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 FARRINGTON DR
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-2502
Practice Address - Country:US
Practice Address - Phone:847-571-7816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.005027133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered