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NPI Code Detail

MEDICARE: STEFANIE LYNN M.S., R.D.

MEDICARE: STEFANIE LYNN M.S., R.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
1133V00000XRegistered Dietitian1017397NY

General Provider Information

NPI Number : 1386989911
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEFANIE LYNN M.S., R.D.
Provider Business Mailing Address
First Line : 1049 WESTERN AVE
Second Line :
City : CHILLICOTHEE
State : OH
Zip : 45601-1104
Country : US
Telephone Number : 740-773-4366
Fax Number : 740-775-7855
Provider Business Practice Location Address
First Line : 30381 CHIEFTAIN DR
Second Line :
City : LOGAN
State : OH
Zip : 43138-9092
Country : US
Telephone Number : 740-385-2555
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2012
Last Update Date : 03/22/2018

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