Healthcare Provider Details

I. General information

NPI: 1629488713
Provider Name (Legal Business Name): LINDSEY DUBAS RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 08/29/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 CORONA AVE
PALMER LAKE CO
80133
US

IV. Provider business mailing address

431 CORONA AVE PO 1648
PALMER LAKE CO
80133
US

V. Phone/Fax

Practice location:
  • Phone: 785-477-2072
  • Fax:
Mailing address:
  • Phone: 785-477-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: