Provider Demographics
NPI:1154567717
Name:BURLINGTON, KELLI D (RD)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:D
Last Name:BURLINGTON
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 1:4535 NORMAL BLVD STE 158
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2890
Mailing Address - Country:US
Mailing Address - Phone:402-483-4770
Mailing Address - Fax:402-483-5385
Practice Address - Street 1:4535 NORMAL BLVD STE 158
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-2890
Practice Address - Country:US
Practice Address - Phone:402-483-4770
Practice Address - Fax:402-483-5385
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE779133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered