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General NPI Number Information
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NPI Number | 1639795727
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Entity Type | Organization
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Legal Business Name | BAMBOO NUTRITION, LLC
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Dates
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Enumeration Date | 06/24/2020
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 1905 CHERRY HILL DR STE 300
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City | COLUMBIA
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State | MO
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Zip | 65203-5812
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Country | US
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Telephone | 573-343-4017
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Fax | 573-615-4443
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Provider Business Mailing Address
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Address Line | 2012 CHERRY HILL DR STE 202B
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City | COLUMBIA
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State | MO
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Zip | 65203-5882
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Country | US
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Telephone | 573-343-4017
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Fax | 573-615-4443
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Authorized Official
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Title or Position | OWNER
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Name | MS. ISABELLE BOUCHARD
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Credential | MS, RDN
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Telephone | 573-343-4017
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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 |
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License Number State |
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