Organization
WESTERN RESERVE NUTRITION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLYN JOSEPH BOUQUOT RDN (OWNER)
(330) 554-9327
Entity
Organization
Contact information
Practice address
9205 STATE ROUTE 43 STE 106, STREETSBORO, OH 44241-5366
(330) 554-9327
(330) 294-5651
Mailing address
5757 BRADFORD WAY, HUDSON, OH 44236-3901
(330) 554-9327
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
4344
OH
Other
Enumeration date
11/07/2016
Last updated
11/12/2020
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