Provider Demographics
NPI:1578993135
Name:BROST, LINDSEY (RD, LDN)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:BROST
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W COLUMBIA AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-1453
Mailing Address - Country:US
Mailing Address - Phone:715-296-0570
Mailing Address - Fax:
Practice Address - Street 1:2001 5TH ST
Practice Address - Street 2:SUITE 51
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-2903
Practice Address - Country:US
Practice Address - Phone:309-792-1507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164005996133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered