Provider Demographics
NPI:1154568459
Name:VINCENT, LYDIA GRACE (RD, LDN)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:GRACE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 N PLANK RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:PA
Mailing Address - Zip Code:18801-8482
Mailing Address - Country:US
Mailing Address - Phone:570-278-4812
Mailing Address - Fax:
Practice Address - Street 1:1444 N PLANK RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:PA
Practice Address - Zip Code:18801-8482
Practice Address - Country:US
Practice Address - Phone:570-436-1275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004027133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered