Basic Information
| Provider Information | |||||||||
| NPI: | 1922056571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOVORSKA | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | ANNETTE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | R.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 PHAR LAP LN | ||||||||
| Address2: | |||||||||
| City: | BAHAMA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275039216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192860411 | ||||||||
| FaxNumber: | 9194165825 | ||||||||
| Practice Location | |||||||||
| Address1: | 508 FULTON ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277053875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194710116 | ||||||||
| FaxNumber: | 9194165825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | L001479 | NC | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.