Healthcare Provider Details

I. General information

NPI: 1720235245
Provider Name (Legal Business Name): JENNIFER LYNN BURNELL MS, RD/LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR EATING DISORDERS PROGRAM
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

211 FRIDAY CENTER DR SUITE 2091, ROOM 2012
CHAPEL HILL NC
27517-9499
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-8857
  • Fax:
Mailing address:
  • Phone: 919-966-0420
  • Fax: 919-966-9983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL003260
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: