Healthcare Provider Details

I. General information

NPI: 1366592578
Provider Name (Legal Business Name): ANNETTE MARIE LYNCH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BUENA VISTA CIR CARE OF FOOD AND NUTRITION SERVICES
SOUTH HILL VA
23970-1431
US

IV. Provider business mailing address

125 BUENA VISTA CIR CARE OF FOOD AND NUTRITION SERVICES
SOUTH HILL VA
23970-1431
US

V. Phone/Fax

Practice location:
  • Phone: 434-447-3151
  • Fax:
Mailing address:
  • Phone: 434-447-3151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: