Healthcare Provider Details

I. General information

NPI: 1790081594
Provider Name (Legal Business Name): CHERYL L BURNS R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL L GRESL

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 N RUTLEDGE ST STE 300
SPRINGFIELD IL
62702-4968
US

IV. Provider business mailing address

PO BOX 19654
SPRINGFIELD IL
62794-9654
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-1229
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164-000220
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number164-000220
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: