MEDICARE: MS. LAURA SUE BURDICK R.D., L.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	5008	OH

General Provider Information

NPI Number	:	1497751507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA SUE BURDICK R.D., L.D.

Provider Business Mailing Address
First Line	:	6910 MARGARUM BND
Second Line	:
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-7044
Country	:	US
Telephone Number	:	614-775-9171
Fax Number	:

Provider Business Practice Location Address
First Line	:	6910 MARGARUM BND
Second Line	:
City	:	NEW ALBANY
State	:	OH
Zip	:	43054-7044
Country	:	US
Telephone Number	:	614-775-9171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/08/2007

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