Provider Demographics
NPI:1255343935
Name:NORBERT, KIM P (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:P
Last Name:NORBERT
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 LESTER DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1613
Mailing Address - Country:US
Mailing Address - Phone:207-878-2245
Mailing Address - Fax:
Practice Address - Street 1:805 STEVENS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2626
Practice Address - Country:US
Practice Address - Phone:207-772-6279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI304133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME11339809OtherCAQH
ME11339809OtherCAQH
MENOMT0630Medicare ID - Type Unspecified