Healthcare Provider Details

I. General information

NPI: 1518493030
Provider Name (Legal Business Name): LYNN UMBREIT MS, RDN, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3923 OXBOW VILLAGE LN NW
ALBUQUERQUE NM
87120-1179
US

IV. Provider business mailing address

3923 OXBOW VILLAGE LN NW
ALBUQUERQUE NM
87120-1179
US

V. Phone/Fax

Practice location:
  • Phone: 505-301-6240
  • Fax:
Mailing address:
  • Phone: 505-301-6240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number556
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: