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General NPI Number Information
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NPI Number | 1720619646
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Entity Type | Individual
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Provider Name | JENNIFER BURNETT RDN
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Gender | Female
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Dates
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Enumeration Date | 01/29/2020
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 3600 NW SAMARITAN DR
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City | CORVALLIS
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State | OR
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Zip | 97330-3737
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Country | US
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Telephone | 541-768-4663
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 NW SAMARITAN DR
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City | CORVALLIS
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State | OR
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Zip | 97330-3737
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86084202
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License Number State |
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