Basic Information
| Provider Information | |||||||||
| NPI: | 1902827207 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOLDUC | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MS, RD,LD,CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 WHITING HILL | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BREWER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079737334 | ||||||||
| FaxNumber: | 2079737424 | ||||||||
| Practice Location | |||||||||
| Address1: | 905 UNION ST | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044013050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079737334 | ||||||||
| FaxNumber: | 2079737424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | D1517 | ME | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.