Provider Demographics
NPI:1215773601
Name:BOUTRS, CHRISTINE (LDRD)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:
Last Name:BOUTRS
Suffix:
Gender:F
Credentials:LDRD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:GIRGIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:4813 FULBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:TX
Mailing Address - Zip Code:75002-2883
Mailing Address - Country:US
Mailing Address - Phone:201-841-8204
Mailing Address - Fax:
Practice Address - Street 1:4813 FULBROOK DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:TX
Practice Address - Zip Code:75002-2883
Practice Address - Country:US
Practice Address - Phone:201-841-8204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ85002090133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered