Provider Demographics
NPI:1861062408
Name:MENCH, LINDA (MS, CNS)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MENCH
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 KLOMAN ST
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2228
Mailing Address - Country:US
Mailing Address - Phone:571-999-3632
Mailing Address - Fax:
Practice Address - Street 1:4007 KLOMAN ST
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2228
Practice Address - Country:US
Practice Address - Phone:571-999-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA18196133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education