Provider Demographics
NPI:1760654446
Name:BUMP, LINDA JOAN (RD REGISTERED DIETIT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JOAN
Last Name:BUMP
Suffix:
Gender:F
Credentials:RD REGISTERED DIETIT
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:JOAN
Other - Last Name:FOBES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55353 CEDAR HAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:MAX
Mailing Address - State:MN
Mailing Address - Zip Code:56659
Mailing Address - Country:US
Mailing Address - Phone:218-244-7470
Mailing Address - Fax:
Practice Address - Street 1:55353 CEDAR HAVEN WAY
Practice Address - Street 2:
Practice Address - City:MAX
Practice Address - State:MN
Practice Address - Zip Code:56659
Practice Address - Country:US
Practice Address - Phone:218-244-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1038133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered