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General NPI Number Information
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NPI Number | 1497730915
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Entity Type | Individual
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Provider Name | GRETA ANN GOODPASTURE HOPKE R.D., L.D.
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Gender | Female
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Dates
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Enumeration Date | 12/07/2005
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Last Update Date | 08/06/2010
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Provider Practice Location Address
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Address Line | 19 N MAIN CROSS ST
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City | BOWLING GREEN
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State | MO
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Zip | 63334-1643
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Country | US
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Telephone | 573-324-2111
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Fax | 573-324-3057
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Provider Business Mailing Address
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Address Line | 44871 HIGHWAY WW
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City | VANDALIA
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State | MO
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Zip | 63382-4501
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Country | US
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Telephone | 573-594-2826
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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 | 2005015547
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License Number State | MO
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