Basic Information
| Provider Information | |||||||||
| NPI: | 1114911914 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NORMAN | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | BS, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 249 | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986327154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604142048 | ||||||||
| FaxNumber: | 3605756749 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986323256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606364943 | ||||||||
| FaxNumber: | 3604147674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DI00000517 | WA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 8290173 | 05 | WA | MEDICAID | 100437 | 05 | OR | MEDICAID |