Provider Demographics
NPI:1003056771
Name:MACDONNELL, MICHELE LEE (RD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEE
Last Name:MACDONNELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LEE
Other - Last Name:BURKERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:21 ELM STREET
Mailing Address - Street 2:NEW MILFORD HOSPITAL
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776
Mailing Address - Country:US
Mailing Address - Phone:860-350-7289
Mailing Address - Fax:
Practice Address - Street 1:21 ELM STREET
Practice Address - Street 2:NEW MILFORD HOSPITAL
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776
Practice Address - Country:US
Practice Address - Phone:860-350-7289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000862133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered