Provider Demographics
NPI:1477391886
Name:LINCOLN, BARBARA BROOKE (RD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:BROOKE
Last Name:LINCOLN
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 1:533 OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-2042
Mailing Address - Country:US
Mailing Address - Phone:914-582-8390
Mailing Address - Fax:
Practice Address - Street 1:533 OAKDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENCOE
Practice Address - State:IL
Practice Address - Zip Code:60022-2042
Practice Address - Country:US
Practice Address - Phone:914-582-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1003087133VN1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management