Bourn, Brenda Lynn

Bourn, Brenda Lynn is an individual health care provider with primary practice located at 1226 W River St , Boise ID 83702-7049. She recently has only one registered license in Dietary & Nutritional Service Providers / Dietitian, Registered, which is considered as her primary health care specialty. Bourn, Brenda Lynn can be contacted via phone (208) 331-1155.

Contact Information

Primary practice address
1226 W River St Boise ID 83702-7049
Phone: (208) 331-1155
Fax: (208) 383-0190
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X 00864302 Arizona
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X 00777 New Mexico
Dietary & Nutritional Service Providers / Dietitian, Registered 133V00000X D-742 Idaho

Profile Details

NPI number 1477728178
LBN Legal business name Bourn, Brenda Lynn
Credentials Registered Dietitian (RD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 24th, 2008
Last updated Jul 8th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477728178 NPPES
Idaho MEDICAID 1477728178

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