Provider Demographics
NPI:1689798134
Name:SCHWIEGERAHT, LYNNETTE SUE (MED, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:LYNNETTE
Middle Name:SUE
Last Name:SCHWIEGERAHT
Suffix:
Gender:F
Credentials:MED, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4044 BATTLEGROUND AVE
Mailing Address - Street 2:APT 3F
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9787
Mailing Address - Country:US
Mailing Address - Phone:336-202-3558
Mailing Address - Fax:
Practice Address - Street 1:122 N ELM ST
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2878
Practice Address - Country:US
Practice Address - Phone:336-334-5601
Practice Address - Fax:336-334-5657
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002908133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3403407Medicaid