Provider Demographics
NPI:1669159604
Name:BURDNO, MARIAH M (RD, LD)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:M
Last Name:BURDNO
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 1:5466 SCOTCH CAP DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-7758
Mailing Address - Country:US
Mailing Address - Phone:505-803-1571
Mailing Address - Fax:
Practice Address - Street 1:5466 SCOTCH CAP DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-7758
Practice Address - Country:US
Practice Address - Phone:505-803-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV40260-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered