Provider Demographics
NPI:1760819163
Name:BURTNETT, DAWN MICHELE (RDN)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MICHELE
Last Name:BURTNETT
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 S BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-2362
Mailing Address - Country:US
Mailing Address - Phone:248-393-7707
Mailing Address - Fax:248-393-7708
Practice Address - Street 1:3009 S BALDWIN RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-2362
Practice Address - Country:US
Practice Address - Phone:248-393-7707
Practice Address - Fax:248-393-7708
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO840067133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered