Provider Demographics
NPI:1780866657
Name:EVERETT, LINDSEY MARIE (RDLD)
Entity Type:Individual
Prefix:MS
First Name:LINDSEY
Middle Name:MARIE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4330
Mailing Address - Country:US
Mailing Address - Phone:712-264-6605
Mailing Address - Fax:712-264-6656
Practice Address - Street 1:1200 1ST AVE E
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4330
Practice Address - Country:US
Practice Address - Phone:712-264-6605
Practice Address - Fax:712-264-6656
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001798133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI21829Medicare PIN