Healthcare Provider Details

I. General information

NPI: 1730613209
Provider Name (Legal Business Name): LINDA M BIRKEMEIER MS, RDN, LD, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDA M CARDINAL MS, RDN, LD, CDCES

II. Dates (important events)

Enumeration Date: 04/12/2017
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 RONALD REAGAN PKWY
AVON IN
46123-7085
US

IV. Provider business mailing address

737 DAYBREAK DR
AVON IN
46123-9858
US

V. Phone/Fax

Practice location:
  • Phone: 215-292-2364
  • Fax:
Mailing address:
  • Phone: 215-292-2364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number146
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37004070A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: