Provider Demographics
NPI:1144335266
Name:HOST, KAREN REGINA (MA, RD, CDE)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:REGINA
Last Name:HOST
Suffix:
Gender:F
Credentials:MA, RD, CDE
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:REGINA
Other - Last Name:BOMMARITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, RD, CDE
Mailing Address - Street 1:5838 METRO WAY SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9619
Mailing Address - Country:US
Mailing Address - Phone:616-249-5300
Mailing Address - Fax:616-249-5461
Practice Address - Street 1:5838 METRO WAY SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9619
Practice Address - Country:US
Practice Address - Phone:616-249-5300
Practice Address - Fax:616-249-5461
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered