Provider Demographics
NPI:1730528423
Name:GARRIS, LYNNE M (DIETICIAN)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:M
Last Name:GARRIS
Suffix:
Gender:F
Credentials:DIETICIAN
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:DOLAN
Other - Last Name:GARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 827658
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-7658
Mailing Address - Country:US
Mailing Address - Phone:570-420-4951
Mailing Address - Fax:570-476-3754
Practice Address - Street 1:500 PLAZA CT
Practice Address - Street 2:STE D
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8262
Practice Address - Country:US
Practice Address - Phone:570-426-2330
Practice Address - Fax:570-426-2331
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000503133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered