Provider Demographics
NPI:1003108978
Name:RUFF, LYNDSAY JO (RD)
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:JO
Last Name:RUFF
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:LYNDSAY
Other - Middle Name:JO
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:802 W KING ST
Mailing Address - Street 2:SUITE R
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2100
Mailing Address - Country:US
Mailing Address - Phone:989-729-4710
Mailing Address - Fax:989-729-7762
Practice Address - Street 1:802 W KING ST
Practice Address - Street 2:SUITE R
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2100
Practice Address - Country:US
Practice Address - Phone:989-729-4710
Practice Address - Fax:989-729-7762
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1042207133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered