Individual
KIA M BOURNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDN
Contact information
Practice address
14 TREE HOLLOW LN, DIX HILLS, NY 11746-6324
(631) 463-5666
Mailing address
14 TREE HOLLOW LN, DIX HILLS, NY 11746-6324
(631) 463-5666
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86029217
NY
Other
Enumeration date
02/25/2015
Last updated
02/25/2015
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