Provider Demographics
NPI:1457370827
Name:REYNOLDSON, LINDA (RD, LMNT)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:REYNOLDSON
Suffix:
Gender:F
Credentials:RD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2367
Mailing Address - Country:US
Mailing Address - Phone:402-750-3378
Mailing Address - Fax:
Practice Address - Street 1:2412 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2367
Practice Address - Country:US
Practice Address - Phone:402-750-3378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE192133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP58149Medicare UPIN
NE275526Medicare PIN