Basic Information
| Provider Information | |||||||||
| NPI: | 1235181009 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCANLON | ||||||||
| FirstName: | CATHERINE | ||||||||
| MiddleName: | BURTTSCHELL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MS RD LD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BURTTSCHELL | ||||||||
| OtherFirstName: | CATHERINE | ||||||||
| OtherMiddleName: | LYNESE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2460 E GERMANN RD | ||||||||
| Address2: | SUITE 18 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852861572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808831188 | ||||||||
| FaxNumber: | 4808831193 | ||||||||
| Practice Location | |||||||||
| Address1: | 2460 E GERMANN RD | ||||||||
| Address2: | SUITE 18 | ||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852861572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808831188 | ||||||||
| FaxNumber: | 4808831193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 04/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 01703 | IA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.