Individual
MISS KRISTEN BOURQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD, CLC
Contact information
Practice address
9115 HAGUE RD, INDIANAPOLIS, IN 46256-1025
(317) 521-2000
Mailing address
7408 W PALATINE AVE, CHICAGO, IL 60631-1920
(702) 250-7901
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.007743
IL
133V00000X
Registered Dietitian
32149DI-0
NV
Other
Enumeration date
01/16/2015
Last updated
12/15/2021
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