Individual
KIM P NORBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., R.D., L.D.
Contact information
Practice address
805 STEVENS AVE, PORTLAND, ME 04103-2626
(207) 772-6279
Mailing address
77 LESTER DR, PORTLAND, ME 04103-1613
(207) 878-2245
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI304
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11339809
CAQH
ME
Enumeration date
08/12/2006
Last updated
07/09/2007
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