Healthcare Provider Details

I. General information

NPI: 1851635767
Provider Name (Legal Business Name): EMILIE GINNY MARIE LINDSAY RDN, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N ROCKTON AVE
ROCKFORD IL
61103-3619
US

IV. Provider business mailing address

4512 CROSSROADS DR
CLARKSVILLE TN
37040-6124
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-2000
  • Fax:
Mailing address:
  • Phone: 815-262-9203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number164005359
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: