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General NPI Number Information
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NPI Number | 1649696568
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Entity Type | Organization
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Legal Business Name | LYNN SPALDING GERONTOLOGICAL NUTRITION SPECIALIST
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 12516 HIDDENVALE CT
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City | PERRY
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State | MI
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Zip | 48872-9153
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Country | US
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Telephone | 517-290-4816
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Fax | 734-207-5326
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Provider Business Mailing Address
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Address Line | PO BOX 871206
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City | CANTON
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State | MI
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Zip | 48187-6206
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Country | US
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Telephone | 517-290-4816
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Fax | 734-207-5326
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Authorized Official
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Title or Position | OWNER
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Name | LYNN SPALDING
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Credential | RD, CSG
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Telephone | 517-290-4816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 538653
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License Number State | MI
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