Basic Information
| Provider Information | |||||||||
| NPI: | 1144335266 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOST | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | REGINA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, RD, CDE | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BOMMARITO | ||||||||
| OtherFirstName: | KAREN | ||||||||
| OtherMiddleName: | REGINA | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MA, RD, CDE | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5838 METRO WAY SW | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495199619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162495300 | ||||||||
| FaxNumber: | 6162495461 | ||||||||
| Practice Location | |||||||||
| Address1: | 5838 METRO WAY SW | ||||||||
| Address2: | |||||||||
| City: | WYOMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495199619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162495300 | ||||||||
| FaxNumber: | 6162495461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 08/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.