Provider Demographics
NPI:1548475163
Name:BOWERSOX, LINDSAY ERIN (RD, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:ERIN
Last Name:BOWERSOX
Suffix:
Gender:F
Credentials:RD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 CALUMET CT
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-9378
Mailing Address - Country:US
Mailing Address - Phone:209-470-7392
Mailing Address - Fax:
Practice Address - Street 1:681 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5736
Practice Address - Country:US
Practice Address - Phone:530-626-2990
Practice Address - Fax:530-626-2992
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA915310133V00000X
CA105-21916174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered174400000XOther Service ProvidersSpecialist