Provider Demographics
NPI:1699980375
Name:HOOGE, LYDIA STARNS (MS, LDN, RD)
Entity type:Individual
Prefix:MRS
First Name:LYDIA
Middle Name:STARNS
Last Name:HOOGE
Suffix:
Gender:F
Credentials:MS, LDN, RD
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:MARIE
Other - Last Name:STARNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12670 SIMMS RD
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-0462
Mailing Address - Country:US
Mailing Address - Phone:225-387-7678
Mailing Address - Fax:225-387-7670
Practice Address - Street 1:12670 SIMMS RD
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706-0462
Practice Address - Country:US
Practice Address - Phone:225-387-7678
Practice Address - Fax:225-387-7670
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1878133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA930875OtherCDR ID #
LA1878OtherLDN #
LA4H709D071Medicare PIN