Provider Demographics
NPI:1811501380
Name:REPINE, LINDSEY (MS, RD, LDN)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:REPINE
Suffix:
Gender:F
Credentials:MS, RD, LDN
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:
Other - Last Name:MAHOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 STURBRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:EVANS CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16033-3001
Mailing Address - Country:US
Mailing Address - Phone:717-350-1524
Mailing Address - Fax:
Practice Address - Street 1:101 STURBRIDGE LN
Practice Address - Street 2:
Practice Address - City:EVANS CITY
Practice Address - State:PA
Practice Address - Zip Code:16033-3001
Practice Address - Country:US
Practice Address - Phone:717-350-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004831133N00000X, 133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist