Individual
LINDSAY PAIGE BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
1911 COOKS HILL RD, CENTRALIA, WA 98531-9073
(360) 736-6778
(360) 736-6552
Mailing address
519 NW QUINCY PL, CHEHALIS, WA 98532-1629
(360) 736-6778
(360) 736-6552
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DI60220652
WA
133VN1005X
Renal Nutrition Registered Dietitian
1006104
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2040828
—
WA
Enumeration date
01/11/2012
Last updated
12/29/2014
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