Individual
JENNIFER BOURBONNAIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED, RD, LDN
Contact information
Practice address
9800 MOODY CT, HARRISBURG, NC 28075-6643
(248) 909-8555
Mailing address
9800 MOODY CT, HARRISBURG, NC 28075-6643
(248) 909-8555
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
864114
MI
133V00000X
Registered Dietitian
Primary
L005862
NC
Other
Enumeration date
03/27/2007
Last updated
09/21/2021
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