NPI 1881083699 · live from the CMS NPI Registry
Kristen Bourque, RD, LD, CLC
Dietitian, Registered in Indianapolis, IN. National Provider Identifier 1881083699, active.
NPI record
| NPI | 1881083699 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dietitian, Registered 133V00000X |
| Practice location | 9115 Hague Rd, Indianapolis, IN 46256 |
| Practice phone | 317-521-2000 |
| Mailing address | 7408 W Palatine Ave, Chicago, IL 60631 |
| Enumerated | January 16, 2015 |
| Last updated | December 15, 2021 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dietitian, Registered | 133V00000X | 32149DI-0 (NV) |
| Dietitian, Registered primary | 133V00000X | 164.007743 (IL) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.