Provider Demographics
NPI:1497095343
Name:ROOT, APRIL LYNN (RD)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:LYNN
Last Name:ROOT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:APRIL
Other - Middle Name:
Other - Last Name:DUONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2201 FOREST HILLS LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2844
Mailing Address - Country:US
Mailing Address - Phone:269-983-4347
Mailing Address - Fax:
Practice Address - Street 1:ST. JOSEPH COUNTY VA CLINIC
Practice Address - Street 2:1540 TRINITY PLACE
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545
Practice Address - Country:US
Practice Address - Phone:574-272-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37001381A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered