Provider Demographics
NPI:1275684813
Name:BOGETTA, HEATHER ELIZABETH (RD)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:BOGETTA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14813 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-8636
Mailing Address - Country:US
Mailing Address - Phone:616-402-4466
Mailing Address - Fax:
Practice Address - Street 1:829 FOREST HILL AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2325
Practice Address - Country:US
Practice Address - Phone:616-949-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education