Provider Demographics
NPI:1104452747
Name:PRZYSTAC, LYNN ELLEN (RDN, LDN)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:ELLEN
Last Name:PRZYSTAC
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DUDLEY ST DEPT OF
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2499
Mailing Address - Country:US
Mailing Address - Phone:401-274-1122
Mailing Address - Fax:401-453-7572
Practice Address - Street 1:101 DUDLEY ST DEPT OF
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905-2499
Practice Address - Country:US
Practice Address - Phone:401-274-1122
Practice Address - Fax:401-453-7572
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00217133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered