MEDICARE: LINDSEY MENGE MS, RD, LD

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	133NN1002X	Nutrition Education Nutritionist	DT86112	TX
2	133VN1301X	Oncology Nutrition Registered Dietitian	DT86112	TX
3	133V00000X	Registered Dietitian	DT86112	TX

General Provider Information

NPI Number	:	1508406232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY MENGE MS, RD, LD

Provider Business Mailing Address
First Line	:	7602 WHISPERING OAKS DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-5935
Country	:	US
Telephone Number	:	512-565-0671
Fax Number	:

Provider Business Practice Location Address
First Line	:	4130 SPICEWOOD SPRINGS RD STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8657
Country	:	US
Telephone Number	:	512-565-0671
Fax Number	:

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

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	01/10/2020

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