Provider Demographics
NPI:1093152829
Name:DALLUGE, LINDSAY ANN (RD, LD)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ANN
Last Name:DALLUGE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4441
Mailing Address - Country:US
Mailing Address - Phone:507-238-4323
Mailing Address - Fax:
Practice Address - Street 1:907 S STATE ST
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4441
Practice Address - Country:US
Practice Address - Phone:507-238-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3102133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered