Provider Demographics
NPI:1891378501
Name:BURDEN, CARRIE LYNN (MS, CNS, LDN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:BURDEN
Suffix:
Gender:F
Credentials:MS, CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 NEWMAN RD
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073-1925
Mailing Address - Country:US
Mailing Address - Phone:267-328-7642
Mailing Address - Fax:
Practice Address - Street 1:300 BROOKSIDE AVE STE 180
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-3436
Practice Address - Country:US
Practice Address - Phone:484-416-4189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN007281133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education