Individual
EMILY BOURQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD, LD
Contact information
Practice address
123 TWIN MEADOW LN, LAFAYETTE, LA 70508-8326
(727) 201-2495
Mailing address
123 TWIN MEADOW LN, LAFAYETTE, LA 70508-8326
(337) 945-2836
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND8574
FL
Other
Enumeration date
08/08/2019
Last updated
12/13/2021
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