Organization
BAMBOO NUTRITION, LLC
Active
Other names
Bamboo Nutrition
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ISABELLE BOUCHARD MS, RDN (OWNER)
(573) 343-4017
Entity
Organization
Contact information
Practice address
1905 CHERRY HILL DR STE 300, COLUMBIA, MO 65203-5812
(573) 343-4017
(573) 615-4443
Mailing address
2012 CHERRY HILL DR STE 202B, COLUMBIA, MO 65203-5882
(573) 343-4017
(573) 615-4443
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017032772
MISSOURI DIVISION OF PROFESSIONAL REGISTRATION
MO
01
—
2018035632
MISSOURI DIVISION OF PROFESSIONAL REGISTRATION
MO
Enumeration date
06/24/2020
Last updated
01/27/2026
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