Provider Demographics
NPI:1427348655
Name:DAGHER, LINA (RD)
Entity type:Individual
Prefix:
First Name:LINA
Middle Name:
Last Name:DAGHER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22158 W VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2298
Mailing Address - Country:US
Mailing Address - Phone:313-683-0030
Mailing Address - Fax:
Practice Address - Street 1:22158 W VILLAGE DR
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2298
Practice Address - Country:US
Practice Address - Phone:313-683-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI995418133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered