Provider Demographics
NPI:1629196670
Name:MCPHEE, LYNNE MARIE (RD, CDE, CDN)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:MCPHEE
Suffix:
Gender:F
Credentials:RD, CDE, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MANSFIELD AVE
Mailing Address - Street 2:NUTRITION SERVICES DEPT
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2041
Mailing Address - Country:US
Mailing Address - Phone:860-456-6863
Mailing Address - Fax:860-456-6966
Practice Address - Street 1:112 MANSFIELD AVE
Practice Address - Street 2:NUTRITION SERVICES DEPT
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2041
Practice Address - Country:US
Practice Address - Phone:860-456-6863
Practice Address - Fax:860-456-6966
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000572133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered