Provider Demographics
NPI:1083933881
Name:SURRELL, LINDSEY (RD)
Entity Type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:
Last Name:SURRELL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 5TH ST NW
Mailing Address - Street 2:APT 1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4816
Mailing Address - Country:US
Mailing Address - Phone:770-265-5989
Mailing Address - Fax:
Practice Address - Street 1:1330 5TH ST NW
Practice Address - Street 2:APT 1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4816
Practice Address - Country:US
Practice Address - Phone:770-265-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA968856133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCD1100000379OtherDC LICENSE