Healthcare Provider Details

I. General information

NPI: 1336130137
Provider Name (Legal Business Name): LINDA ALLEN R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 WENDELL AVE #103
LEWISTOWN MT
59457-2267
US

IV. Provider business mailing address

1111 5TH AVE N
LEWISTOWN MT
59457-1419
US

V. Phone/Fax

Practice location:
  • Phone: 406-538-1480
  • Fax: 406-538-1481
Mailing address:
  • Phone: 406-538-1480
  • Fax: 406-538-1481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number471
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: