Provider Demographics
NPI:1245898337
Name:BURKHOLDER, AMY JANE (CNS, LDN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JANE
Last Name:BURKHOLDER
Suffix:
Gender:F
Credentials:CNS, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9210 CROSBY RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1522
Mailing Address - Country:US
Mailing Address - Phone:410-926-4927
Mailing Address - Fax:
Practice Address - Street 1:9210 CROSBY RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1522
Practice Address - Country:US
Practice Address - Phone:410-926-4927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX4025133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist