Provider Demographics
NPI:1801064795
Name:BURDICK, DONNA JEAN (RD REG DIETITIAN)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEAN
Last Name:BURDICK
Suffix:
Gender:F
Credentials:RD REG DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3331
Mailing Address - Country:US
Mailing Address - Phone:607-734-6135
Mailing Address - Fax:607-734-8918
Practice Address - Street 1:163 SULLIVAN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3331
Practice Address - Country:US
Practice Address - Phone:607-734-6135
Practice Address - Fax:607-734-8918
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY832297133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered