Healthcare Provider Details

I. General information

NPI: 1033376447
Provider Name (Legal Business Name): MARILYN ANNE BURCH R.D., C.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 SE BISHOP BLVD
PULLMAN WA
99163-5512
US

IV. Provider business mailing address

835 SE BISHOP BLVD
PULLMAN WA
99163-5512
US

V. Phone/Fax

Practice location:
  • Phone: 509-336-7543
  • Fax: 509-336-7642
Mailing address:
  • Phone: 509-336-7543
  • Fax: 509-336-7642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00000063
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: