MEDICARE: LINDSAY FRANK KEENEY RD, LD, CD, CNSC

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	2932	MN
2	133V00000X	Registered Dietitian	3185-29	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2932	OTHER	MN	DIETETIC LICENSURE
2	3185-29	OTHER	WI	CERTIFIED DIETITIAN

General Provider Information

NPI Number	:	1851607113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY FRANK KEENEY RD, LD, CD, CNSC

Provider Business Mailing Address
First Line	:	8837 N IROQUOIS RD
Second Line	:
City	:	BAYSIDE
State	:	WI
Zip	:	53217-1712
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5261 N PORT WASHINGTON RD STE 201
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53217-4903
Country	:	US
Telephone Number	:	206-948-8810
Fax Number	:	503-893-3038

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

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	03/17/2018

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