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General NPI Number Information
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NPI Number | 1255343935
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Entity Type | Individual
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Provider Name | KIM P NORBERT M.S., R.D., L.D.
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Gender | Female
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 805 STEVENS AVE
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City | PORTLAND
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State | ME
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Zip | 04103-2626
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Country | US
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Telephone | 207-772-6279
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Fax |
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Provider Business Mailing Address
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Address Line | 77 LESTER DR
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City | PORTLAND
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State | ME
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Zip | 04103-1613
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Country | US
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Telephone | 207-878-2245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | DI304
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License Number State | ME
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