NPI 1053920025 · live from the CMS NPI Registry
Nicole P Bomar, RD
Dietitian, Registered in Slater, MO. National Provider Identifier 1053920025, active.
NPI record
| NPI | 1053920025 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 515 Rich St, Slater, MO 65349 |
| Practice phone | 660-631-3598 |
| Enumerated | July 27, 2020 |
| Last updated | December 2, 2022 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered primary | 133V00000X | 2020020010 (MO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.