Individual
MRS. LORIE ANN BOURNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., R.D., L.D.,
Contact information
Practice address
1000 W 10TH ST, ROLLA, MO 65401-2905
(573) 458-8337
Mailing address
607 E 5TH ST, ROLLA, MO 65401-3416
(573) 647-8727
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
2005002998
MO
Other
Enumeration date
11/10/2015
Last updated
11/10/2015
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