Healthcare Provider Details

I. General information

NPI: 1346504131
Provider Name (Legal Business Name): HEATHER S. BURNS R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER S. HOLDEN R.D.

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4241 HIGHWAY 14 WEST
CHRISTOPHER IL
62822-0155
US

IV. Provider business mailing address

PO BOX 155
CHRISTOPHER IL
62822-0155
US

V. Phone/Fax

Practice location:
  • Phone: 618-724-2436
  • Fax:
Mailing address:
  • Phone: 618-724-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164005077
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: