Provider Demographics
NPI:1699978049
Name:BURKARD, CHRISTINA MARIE (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:BURKARD
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 N WILLIAMSBURG ST
Mailing Address - Street 2:ARLINGTON HEIGHTS
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-2850
Mailing Address - Country:US
Mailing Address - Phone:847-749-4958
Mailing Address - Fax:
Practice Address - Street 1:200 W GOLF RD
Practice Address - Street 2:CENTRE CLUB
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3234
Practice Address - Country:US
Practice Address - Phone:847-990-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered