Provider Demographics
NPI:1811472368
Name:LYNN, NANCY C (RD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:LYNN
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 1:23164 DRAGOON RD
Mailing Address - Street 2:
Mailing Address - City:LIGNUM
Mailing Address - State:VA
Mailing Address - Zip Code:22726-2036
Mailing Address - Country:US
Mailing Address - Phone:540-399-1580
Mailing Address - Fax:540-399-1052
Practice Address - Street 1:23164 DRAGOON RD
Practice Address - Street 2:
Practice Address - City:LIGNUM
Practice Address - State:VA
Practice Address - Zip Code:22726-2036
Practice Address - Country:US
Practice Address - Phone:540-399-1580
Practice Address - Fax:540-399-1052
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA620769133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered