Healthcare Provider Details

I. General information

NPI: 1972386621
Provider Name (Legal Business Name): NICOLE LEE BURNS RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N 4TH ST FL 3
LEBANON PA
17046-5606
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-7853
  • Fax: 717-270-2215
Mailing address:
  • Phone: 717-851-1405
  • Fax: 717-851-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN007461
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: