Provider Demographics
NPI:1164606315
Name:HARRIS, LYNNE JONES (MS RD LDN)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:JONES
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MS RD LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 WRIGHTS MILL RD
Mailing Address - Street 2:
Mailing Address - City:TRAPPE
Mailing Address - State:MD
Mailing Address - Zip Code:21673-1761
Mailing Address - Country:US
Mailing Address - Phone:410-200-4072
Mailing Address - Fax:240-667-3690
Practice Address - Street 1:4720 WRIGHTS MILL RD
Practice Address - Street 2:
Practice Address - City:TRAPPE
Practice Address - State:MD
Practice Address - Zip Code:21673-1761
Practice Address - Country:US
Practice Address - Phone:410-200-4072
Practice Address - Fax:240-667-3690
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01059133V00000X
DEDN-0000763133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD840M534FMedicare UPIN