Provider Demographics
NPI:1568761310
Name:NORRIS, ATHE BAMBAKIDIS (MPH, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:ATHE
Middle Name:BAMBAKIDIS
Last Name:NORRIS
Suffix:
Gender:F
Credentials:MPH, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 RAMBLING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-2201
Mailing Address - Country:US
Mailing Address - Phone:614-581-4783
Mailing Address - Fax:
Practice Address - Street 1:456 RAMBLING BROOK DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-2201
Practice Address - Country:US
Practice Address - Phone:614-581-4783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD5277133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered