Provider Demographics
NPI:1326386350
Name:POTTER, LYNN (RD, LDN)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:POTTER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:POTTER
Other - Last Name:BERTSCHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD, LDN
Mailing Address - Street 1:1860 FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-2108
Mailing Address - Country:US
Mailing Address - Phone:570-253-3391
Mailing Address - Fax:
Practice Address - Street 1:1860 FAIR AVE
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-2108
Practice Address - Country:US
Practice Address - Phone:570-253-3391
Practice Address - Fax:570-253-1811
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001449133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered