Provider Demographics
NPI:1679787568
Name:BURNETT, SARA (RD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 VINSANT CIR
Mailing Address - Street 2:
Mailing Address - City:BROOKS CITY-BASE
Mailing Address - State:TX
Mailing Address - Zip Code:78235-1015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WHMC 959 MDTS MTN
Practice Address - Street 2:2200 BERGQUIST DRIVE, SUITE 1
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-9908
Practice Address - Country:US
Practice Address - Phone:210-292-7341
Practice Address - Fax:210-292-7826
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL709319 NATL REGISTR.133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered