Provider Demographics
NPI:1295046779
Name:HOMSTEAD, BRUCE RICHARD (MS BIO/NUTRITION)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:RICHARD
Last Name:HOMSTEAD
Suffix:
Gender:M
Credentials:MS BIO/NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 EAST ST
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1212
Mailing Address - Country:US
Mailing Address - Phone:413-527-7524
Mailing Address - Fax:413-529-8021
Practice Address - Street 1:116 EAST ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1212
Practice Address - Country:US
Practice Address - Phone:413-527-7524
Practice Address - Fax:413-529-8021
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1747133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist