Healthcare Provider Details

I. General information

NPI: 1396811816
Provider Name (Legal Business Name): LYNN KRISTIN MUNSON R.D., L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 BELMONT LN E
MAPLEWOOD MN
55117-2203
US

IV. Provider business mailing address

738 BELMONT LN E
MAPLEWOOD MN
55117-2203
US

V. Phone/Fax

Practice location:
  • Phone: 651-772-0535
  • Fax:
Mailing address:
  • Phone: 651-772-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1475
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: