Organization
ANNIE BURDINE NUTRITION, LLC
Active
Other names
Defore-Burdine, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANNE E BURDINE RD, LDN (OWNER)
(610) 573-1365
Entity
Organization
Contact information
Practice address
184 MAIN ST REAR, EMMAUS, PA 18049-4015
(484) 347-9055
Mailing address
4264 DAVID DR, EMMAUS, PA 18049-9606
(610) 573-1365
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083966469
—
PA
Enumeration date
09/04/2019
Last updated
02/05/2020
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