Provider Demographics
NPI:1487375911
Name:LINDMARK, CHRISTINA LEE (RDN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LEE
Last Name:LINDMARK
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:LEE
Other - Last Name:BUEROSSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:W341N7040 NORTHERN LIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-1364
Mailing Address - Country:US
Mailing Address - Phone:262-361-2194
Mailing Address - Fax:
Practice Address - Street 1:W341N7040 NORTHERN LIGHTS DR
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-1364
Practice Address - Country:US
Practice Address - Phone:262-361-2194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered