Provider Demographics
NPI:1629563069
Name:BOISSIERE, DONNA (CNT, CHT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:BOISSIERE
Suffix:
Gender:F
Credentials:CNT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 TRANCAS ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2905
Mailing Address - Country:US
Mailing Address - Phone:707-227-4795
Mailing Address - Fax:
Practice Address - Street 1:1085 TRANCAS ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2905
Practice Address - Country:US
Practice Address - Phone:707-227-4795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist