Provider Demographics
NPI:1083962922
Name:KILMER, LINDA CAROL (RD,CDN)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:CAROL
Last Name:KILMER
Suffix:
Gender:F
Credentials:RD,CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 ROSSMAN CIR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-3217
Mailing Address - Country:US
Mailing Address - Phone:518-822-1316
Mailing Address - Fax:
Practice Address - Street 1:43 ROSSMAN CIR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-3217
Practice Address - Country:US
Practice Address - Phone:518-822-1316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY967218133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered