MEDICARE: STEPHANIE R BURKE MS, RD, LD, CLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	5446	OH

General Provider Information

NPI Number	:	1235374273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE R BURKE MS, RD, LD, CLC

Provider Business Mailing Address
First Line	:	5348 EDGER DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-7737
Country	:	US
Telephone Number	:	513-385-5655
Fax Number	:

Provider Business Practice Location Address
First Line	:	5348 EDGER DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-7737
Country	:	US
Telephone Number	:	513-385-5655
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2008
Last Update Date	:	12/04/2008

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