MEDICARE: LINDSAY HENLEY RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	60172359	WA

General Provider Information

NPI Number	:	1295031987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY HENLEY RD

Provider Business Mailing Address
First Line	:	594 BEAVER VALLEY RD
Second Line	:
City	:	NEWPORT
State	:	WA
Zip	:	99156-8779
Country	:	US
Telephone Number	:	509-840-9053
Fax Number	:

Provider Business Practice Location Address
First Line	:	328 W 4TH ST
Second Line	:
City	:	NEWPORT
State	:	WA
Zip	:	99156-9094
Country	:	US
Telephone Number	:	509-840-9053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2011
Last Update Date	:	01/10/2025

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Directions to “ LINDSAY HENLEY RD” Practice Location

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