Provider Demographics
NPI:1518218908
Name:SPALDING, LYNN (RD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:SPALDING
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 1:12516 HIDDENVALE CT
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:MI
Mailing Address - Zip Code:48872-9153
Mailing Address - Country:US
Mailing Address - Phone:517-290-4816
Mailing Address - Fax:
Practice Address - Street 1:12516 HIDDENVALE CT
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:MI
Practice Address - Zip Code:48872-9153
Practice Address - Country:US
Practice Address - Phone:517-290-4816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI538653133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered