Individual
MARY LOUISE BURBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
540 SAYBROOK RD STE 100, MIDDLETOWN, CT 06457-4760
(860) 287-1078
Mailing address
179 RUSSELL ST, MIDDLETOWN, CT 06457-4323
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
001431
CT
Other
Enumeration date
12/30/2019
Last updated
12/30/2019
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