Provider Demographics
NPI:1013455641
Name:PETERS, BERNADINE (NUTRITIONISTS)
Entity Type:Individual
Prefix:MRS
First Name:BERNADINE
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:NUTRITIONISTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 DR MARTIN L KING JR AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36603-5341
Mailing Address - Country:US
Mailing Address - Phone:251-436-7754
Mailing Address - Fax:251-436-7765
Practice Address - Street 1:1303 DR MARTIN L KING JR AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-5341
Practice Address - Country:US
Practice Address - Phone:251-436-7751
Practice Address - Fax:251-436-7765
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No133N00000XDietary & Nutritional Service ProvidersNutritionist