Provider Demographics
NPI:1407980444
Name:STACY, LYNN (RD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:STACY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:BESAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6210
Mailing Address - Country:US
Mailing Address - Phone:707-826-8610
Mailing Address - Fax:707-826-8623
Practice Address - Street 1:770 10TH ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6210
Practice Address - Country:US
Practice Address - Phone:707-826-8610
Practice Address - Fax:707-826-8623
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360148133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered