Provider Demographics
NPI:1295926988
Name:BURK, ANN A (RD,LD)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:A
Last Name:BURK
Suffix:
Gender:F
Credentials:RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 DEARBORN DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4767
Mailing Address - Country:US
Mailing Address - Phone:614-840-3500
Mailing Address - Fax:614-840-3510
Practice Address - Street 1:1250 DEARBORN DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43085-4767
Practice Address - Country:US
Practice Address - Phone:614-840-3500
Practice Address - Fax:614-840-3510
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD289133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered