Provider Demographics
NPI:1457499030
Name:LEE, LINDA L (MS, MBA, RD)
Entity Type:Individual
Prefix:PROF
First Name:LINDA
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:MS, MBA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 CONRAD WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-6099
Mailing Address - Country:US
Mailing Address - Phone:908-672-9105
Mailing Address - Fax:
Practice Address - Street 1:2209 CONRAD WAY
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-6099
Practice Address - Country:US
Practice Address - Phone:908-672-9105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
430153133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic