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General NPI Number Information
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NPI Number | 1588065429
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Entity Type | Organization
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Legal Business Name | LUCINDA LYNN EARLE
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Dates
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Enumeration Date | 09/10/2014
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 260 GRAYSON RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-4345
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Country | US
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Telephone | 757-623-9014
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Fax |
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Provider Business Mailing Address
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Address Line | 629 VIRGINIA AVE
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City | NORFOLK
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State | VA
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Zip | 23508-2945
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Country | US
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Telephone | 757-623-9014
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Fax |
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Authorized Official
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Title or Position | REGISTERED DIETITITAN NUTRITIONIST
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Name | LUCINDA LYNN EARLE
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Credential | MPH, RDN
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Telephone | 757-623-9014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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