Healthcare Provider Details

I. General information

NPI: 1083962922
Provider Name (Legal Business Name): LINDA CAROL KILMER RD,CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 ROSSMAN CIR
HUDSON NY
12534-3217
US

IV. Provider business mailing address

43 ROSSMAN CIR
HUDSON NY
12534-3217
US

V. Phone/Fax

Practice location:
  • Phone: 518-822-1316
  • Fax:
Mailing address:
  • Phone: 518-822-1316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number967218
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: