Provider Demographics
NPI:1972329449
Name:NORMAN, LYDIA (RD)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:NORMAN
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 1:1295 BANDANA BOULEVARD WEST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41 PERIMETER CTR E STE 640
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30346-1903
Practice Address - Country:US
Practice Address - Phone:770-871-3730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-29
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006860133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered