Provider Demographics
NPI:1598872905
Name:BURNETT, DANA MARIE (RD)
Entity Type:Individual
Prefix:MS
First Name:DANA
Middle Name:MARIE
Last Name:BURNETT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35904-3047
Mailing Address - Country:US
Mailing Address - Phone:256-546-9265
Mailing Address - Fax:256-549-0376
Practice Address - Street 1:3001 SCENIC HWY
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35904-3047
Practice Address - Country:US
Practice Address - Phone:256-546-9265
Practice Address - Fax:256-549-0376
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL605982133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL605982OtherLICENSE
ALD632Medicare PIN