Provider Demographics
NPI:1992297402
Name:NGUYEN, LINDA THI (MA, RD, LD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MA, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4846 MOHEGAN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-5713
Mailing Address - Country:US
Mailing Address - Phone:314-281-0570
Mailing Address - Fax:
Practice Address - Street 1:16211 BAXTER RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4777
Practice Address - Country:US
Practice Address - Phone:636-536-9679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016040931133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered