Provider Demographics
NPI:1467654954
Name:SEVERY, LYNNETTE (MS, RD, CD)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:
Last Name:SEVERY
Suffix:
Gender:F
Credentials:MS, RD, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7821 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-1059
Mailing Address - Country:US
Mailing Address - Phone:603-545-9766
Mailing Address - Fax:
Practice Address - Street 1:7821 N 10TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-1059
Practice Address - Country:US
Practice Address - Phone:603-545-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001496133VN1004X
NH0639133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8386674Medicare ID - Type UnspecifiedDSHS