Provider Demographics
NPI:1891845855
Name:GLAZEWSKI, LYNN ROMAINE (RD, MPH)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ROMAINE
Last Name:GLAZEWSKI
Suffix:
Gender:F
Credentials:RD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:794 PENINSULA CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2508
Mailing Address - Country:US
Mailing Address - Phone:734-665-9121
Mailing Address - Fax:734-936-7529
Practice Address - Street 1:1500 E. MEDICAL CENTER DR.
Practice Address - Street 2:2A237-UH, BOX 0056
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-0056
Practice Address - Country:US
Practice Address - Phone:734-936-7528
Practice Address - Fax:734-936-7529
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN79860004Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER