Provider Demographics
NPI:1417024589
Name:FARMER, B LYNN (MA, RD)
Entity Type:Individual
Prefix:MRS
First Name:B LYNN
Middle Name:
Last Name:FARMER
Suffix:
Gender:F
Credentials:MA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10316 WARREN RD
Mailing Address - Street 2:P.O. BOX 1217
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3051
Mailing Address - Country:US
Mailing Address - Phone:804-672-1744
Mailing Address - Fax:
Practice Address - Street 1:10316 WARREN RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3051
Practice Address - Country:US
Practice Address - Phone:804-672-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILR550898133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54-1684110OtherEIN