Provider Demographics
NPI:1851712772
Name:LINDSLEY, DAVID (RD, LD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:LINDSLEY
Suffix:
Gender:M
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 NE 77TH AVE
Mailing Address - Street 2:SUITE 275
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6829
Mailing Address - Country:US
Mailing Address - Phone:360-771-4826
Mailing Address - Fax:360-326-1621
Practice Address - Street 1:4400 NE 77TH AVE
Practice Address - Street 2:SUITE 275
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6829
Practice Address - Country:US
Practice Address - Phone:360-771-4826
Practice Address - Fax:360-326-1621
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001197133VN1006X, 133VN1004X, 133V00000X, 133N00000X
OR000597133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADI00001197Medicaid