| Doctor Name: | BRENDA LYNN BOURN |
| NPI Number: | 1477728178 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RD |
| License Number: | 00864302 |
| Business Practice Address: | 1226 W River St Boise, ID - 837027049 |
| Business Phone Number: | 2083311155 |
| Business Fax Number: | 2083830190 |
| Mailing Address: | 190 E Bannock St, BOISE |
| State: | ID |
| Postal Code: | 837126241 |
| Phone Number: | 2083812222 |
| Fax Number: | |
| NPI Enumeration Date: | 04/24/2008 |
| NPI Last Update Date: | 07/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | 00864302 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |