Provider Demographics
NPI:1548320997
Name:LEDUC, LYNETTE (RD)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:LEDUC
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 1:130 COPPER MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-8934
Mailing Address - Country:US
Mailing Address - Phone:507-385-6371
Mailing Address - Fax:507-385-8560
Practice Address - Street 1:1025 MARSH ST
Practice Address - Street 2:RM 1904
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4752
Practice Address - Country:US
Practice Address - Phone:507-385-6371
Practice Address - Fax:507-385-8560
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1675133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered