Provider Demographics
NPI:1093341133
Name:LUNDQUIST, CHLOE (RD, LN)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:RD, LN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 1/2 W GALENA ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1508
Mailing Address - Country:US
Mailing Address - Phone:515-537-4477
Mailing Address - Fax:
Practice Address - Street 1:626 1/2 W GALENA ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1508
Practice Address - Country:US
Practice Address - Phone:406-723-2489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-NUTR-LIC-60435133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered