Provider Demographics
NPI:1528342474
Name:BULLOCH, NORA (RD, MA, MPH)
Entity type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:BULLOCH
Suffix:
Gender:F
Credentials:RD, MA, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:837 FITCH ST
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3704
Mailing Address - Country:US
Mailing Address - Phone:707-331-3898
Mailing Address - Fax:
Practice Address - Street 1:365 TESCONI CIR
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4617
Practice Address - Country:US
Practice Address - Phone:707-575-6043
Practice Address - Fax:707-575-1060
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA809272133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered