Provider Demographics
NPI:1730470386
Name:WELLER, LINDA M (RD,CDE)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:M
Last Name:WELLER
Suffix:
Gender:F
Credentials:RD,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 HARVEST GLEN CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1888
Mailing Address - Country:US
Mailing Address - Phone:540-907-1651
Mailing Address - Fax:
Practice Address - Street 1:4604 SPOTSYLVANIA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-7763
Practice Address - Country:US
Practice Address - Phone:540-423-6600
Practice Address - Fax:540-423-6655
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA711943133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic