Healthcare Provider Details

I. General information

NPI: 1851712772
Provider Name (Legal Business Name): DAVID LINDSLEY RD, LD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 NE 77TH AVE SUITE 275
VANCOUVER WA
98662-6829
US

IV. Provider business mailing address

4400 NE 77TH AVE SUITE 275
VANCOUVER WA
98662-6829
US

V. Phone/Fax

Practice location:
  • Phone: 360-771-4826
  • Fax: 360-326-1621
Mailing address:
  • Phone: 360-771-4826
  • Fax: 360-326-1621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDI00001197
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberDI00001197
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00001197
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDI00001197
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: