Provider Demographics
NPI:1790440980
Name:OETTEL, LINDSEY ANN (MBA, RDN, LDN)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ANN
Last Name:OETTEL
Suffix:
Gender:F
Credentials:MBA, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 S STONE AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-2247
Mailing Address - Country:US
Mailing Address - Phone:708-256-2805
Mailing Address - Fax:
Practice Address - Street 1:1714 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-1441
Practice Address - Country:US
Practice Address - Phone:847-699-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.008574133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered