MEDICARE: LINDSAY ANN DALLUGE R.D., L.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	3102	MN

General Provider Information

NPI Number	:	1093152829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY ANN DALLUGE R.D., L.D.

Provider Business Mailing Address
First Line	:	907 S STATE ST
Second Line	:
City	:	FAIRMONT
State	:	MN
Zip	:	56031-4441
Country	:	US
Telephone Number	:	507-238-4323
Fax Number	:

Provider Business Practice Location Address
First Line	:	907 S STATE ST
Second Line	:
City	:	FAIRMONT
State	:	MN
Zip	:	56031-4441
Country	:	US
Telephone Number	:	507-238-4323
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	06/03/2013

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