Provider Demographics
NPI:1003528332
Name:LAWRENCE, LYNDA FLAVIA (RDN)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:FLAVIA
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 W 170TH ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3226
Mailing Address - Country:US
Mailing Address - Phone:650-248-4863
Mailing Address - Fax:
Practice Address - Street 1:511 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3482
Practice Address - Country:US
Practice Address - Phone:650-248-4863
Practice Address - Fax:207-387-7147
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2023-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
MEDI1928133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered