Provider Demographics
NPI:1720430754
Name:LINNEWEBER, TRACEY M (RD, LD)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:M
Last Name:LINNEWEBER
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4571 W TERRE HAUTE RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47471-5209
Mailing Address - Country:US
Mailing Address - Phone:812-699-9135
Mailing Address - Fax:
Practice Address - Street 1:4571 W TERRE HAUTE RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47471-5209
Practice Address - Country:US
Practice Address - Phone:812-699-9135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN37003200A133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered