Provider Demographics
NPI:1790227908
Name:BONE, ALLISON LEIGH (MS, RDN, CEDRD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEIGH
Last Name:BONE
Suffix:
Gender:F
Credentials:MS, RDN, CEDRD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:LEIGH
Other - Last Name:BONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, RD, CEDRD
Mailing Address - Street 1:753 LAINE ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-1130
Mailing Address - Country:US
Mailing Address - Phone:517-775-5008
Mailing Address - Fax:
Practice Address - Street 1:753 LAINE ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1130
Practice Address - Country:US
Practice Address - Phone:517-775-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1034794133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI11308OtherMEDICARE