Provider Demographics
NPI:1326483975
Name:OURADA, LINDSAY FAYE (RD)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:FAYE
Last Name:OURADA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 W MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-3171
Mailing Address - Country:US
Mailing Address - Phone:507-532-1242
Mailing Address - Fax:
Practice Address - Street 1:607 W MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-3171
Practice Address - Country:US
Practice Address - Phone:507-532-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3078133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered