Provider Demographics
NPI:1629168182
Name:KAMINSKI, LYNN M (MNT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:MNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 GINGER DRIVE
Mailing Address - Street 2:
Mailing Address - City:TRIADELPHIA
Mailing Address - State:WV
Mailing Address - Zip Code:26059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PARK
Practice Address - Street 2:WHEELING HOSPITAL INC
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3042
Practice Address - Country:US
Practice Address - Phone:304-243-3124
Practice Address - Fax:304-243-6343
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV72133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVKAMT70211Medicare ID - Type Unspecified