Provider Demographics
NPI:1578254223
Name:MICHAELIS, LYNDSEY LEA (RDN)
Entity Type:Individual
Prefix:MRS
First Name:LYNDSEY
Middle Name:LEA
Last Name:MICHAELIS
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 MAGNOLIA CT
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:CO
Mailing Address - Zip Code:80615-9066
Mailing Address - Country:US
Mailing Address - Phone:303-884-1511
Mailing Address - Fax:
Practice Address - Street 1:444 MAGNOLIA CT
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:CO
Practice Address - Zip Code:80615-9066
Practice Address - Country:US
Practice Address - Phone:303-884-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86000515133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered