Provider Demographics
NPI:1821746553
Name:BURNETT, TARAN (MDA, RDN)
Entity Type:Individual
Prefix:
First Name:TARAN
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:MDA, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-0581
Mailing Address - Country:US
Mailing Address - Phone:425-499-0934
Mailing Address - Fax:
Practice Address - Street 1:9 LAKE BELLEVUE DR STE 217
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2454
Practice Address - Country:US
Practice Address - Phone:425-499-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI61004309133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered