Provider Demographics
NPI:1548431968
Name:MAXEY, LYNETTE SUE (RD, CDE)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:SUE
Last Name:MAXEY
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:MI
Mailing Address - Zip Code:49635-9658
Mailing Address - Country:US
Mailing Address - Phone:231-352-2357
Mailing Address - Fax:231-352-2232
Practice Address - Street 1:224 PARK AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635-9658
Practice Address - Country:US
Practice Address - Phone:231-352-2357
Practice Address - Fax:231-352-2232
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN80860006Medicare PIN