Provider Demographics
NPI:1821238502
Name:LINDSTROM, DIANE LOUISE (RD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LOUISE
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 W SPRUCE ST STE 32
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3222
Mailing Address - Country:US
Mailing Address - Phone:509-949-1626
Mailing Address - Fax:509-452-6295
Practice Address - Street 1:1111 W SPRUCE ST STE 32
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3222
Practice Address - Country:US
Practice Address - Phone:509-949-1626
Practice Address - Fax:509-452-6295
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI 00001183133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI00001183OtherWASHINGTON STATE DEPT. OF HEALTH