Provider Demographics
NPI:1578657565
Name:CORMIER, JOAN BIXBY (RD)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:BIXBY
Last Name:CORMIER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MS
Other - First Name:JOAN
Other - Middle Name:MARIE
Other - Last Name:CROUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:175 OLD BELGRADE RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8053
Mailing Address - Country:US
Mailing Address - Phone:207-623-8411
Mailing Address - Fax:207-621-7315
Practice Address - Street 1:175 OLD BELGRADE RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8053
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:207-621-7315
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
R114138133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
R114138OtherADA REGISTRATION NUMBER