Provider Demographics
NPI:1053743450
Name:BURNS, MARGARET T (RD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:T
Last Name:BURNS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:T
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:1148 MAJESTIC VIEW LN
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-3494
Mailing Address - Country:US
Mailing Address - Phone:262-567-2042
Mailing Address - Fax:
Practice Address - Street 1:1148 MAJESTIC VIEW LN
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-3494
Practice Address - Country:US
Practice Address - Phone:262-567-2042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1880-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered